What is the clinical evidence from this study?

Study design: Observational. Population: Ischemic stroke and atrial fibrillation (n=397). Intervention: DOAC plasma levels. Primary outcome: Early stroke recurrence within 3 months.

What does this research mean for the field?

Lower direct oral anticoagulant plasma levels are associated with early ischemic stroke recurrence in atrial fibrillation patients treated with apixaban or dabigatran. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the clinical utility and prognostic value of measuring steady-state direct oral anticoagulant (DOAC) plasma concentrations for secondary stroke prevention.

February 16, 2022Journal of Thrombosis and HaemostasisOpen Access

Monitoring of direct oral anticoagulants plasma levels for secondary stroke prevention

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Key result

Lower DOAC plasma levels are linked to early ischemic stroke recurrence with apixaban and dabigatran.

n=397

Why the study?

The value of measuring functional DOAC plasma levels in community use for patients with atrial fibrillation and ischemic stroke remains undetermined.

Does monitoring DOAC plasma levels predict early stroke recurrence in patients with atrial fibrillation and prior ischemic stroke?

Population

397 patients with ischemic stroke and atrial fibrillation on oral anticoagulants for secondary stroke prevention

Comparison

Measurement of functional DOAC plasma levels during steady state

Design

Observational clinical cohort study

Follow-up

3 months

Authors

GSGabriela SiedlerFriedrich-Alexander-Universität Erlangen-Nürnberg KMKosmas MachaFriedrich-Alexander-Universität Erlangen-Nürnberg SSSvenja StollFriedrich-Alexander-Universität Erlangen-Nürnberg

Discussion

Member takes

Implication

Lower DOAC levels were associated with early recurrence after matching; leaves open whether monitoring improves secondary prevention outcomes.

Key Points

To assess the clinical utility and prognostic value of measuring steady-state direct oral anticoagulant (DOAC) plasma concentrations for secondary stroke prevention.
Conducted an observational cohort study of 397 patients with atrial fibrillation and ischemic stroke receiving DOAC therapy between 2016 and 2020.
Measured steady-state functional DOAC trough levels and monitored patients for early recurrent ischemic stroke and bleeding events over a 3-month follow-up period.
Analyzed clinical predictors of drug levels via multivariate regression and evaluated stroke recurrence risk using propensity score matching.
The mean DOAC plasma trough level was 95.9 ± 66.9 ng/ml, with high glomerular filtration rate independently predicting lower trough levels (multivariate R coefficient: -0.174, P = .014).
During the 3-month follow-up, early ischemic stroke recurrence occurred in 10 patients (3%) and clinically relevant bleeding occurred in 10 patients (3%).
Patients experiencing ischemic stroke recurrence had numerically lower steady-state plasma concentrations of apixaban and dabigatran after propensity score matching.

Study Design

Type

Observational (n=397)

Structured PICO

Does monitoring DOAC plasma levels predict early stroke recurrence in patients with atrial fibrillation and prior ischemic stroke?

Population

397 patients with ischemic stroke and atrial fibrillation on oral anticoagulants for secondary stroke prevention, followed for 3 months.

Exposure

Measurement of functional direct oral anticoagulant (DOAC) plasma levels during steady state

Outcome

Early stroke recurrence within 3 monthshard clinical

Monitoring DOAC plasma levels in patients with atrial fibrillation and prior stroke may help identify those at increased risk for early stroke recurrence, particularly in patients with high glomerular filtration rates.

Cite This Study

Siedler et al. (2022) conducted an observational in Ischemic stroke and atrial fibrillation (n=397). DOAC plasma levels was evaluated on Early stroke recurrence within 3 months. Lower DOAC plasma levels were associated with early ischemic stroke recurrence (which occurred in 3% of patients overall) for those on apixaban and dabigatran.

synapsesocial.com/papers/6aaf7b3edc4bef2ee7d06e1a https://doi.org/10.1111/jth.15677

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

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Implication

Lower DOAC levels were associated with early recurrence after matching; leaves open whether monitoring improves secondary prevention outcomes.

Monitoring of direct oral anticoagulants plasma levels for secondary stroke prevention

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Monitoring of direct oral anticoagulants plasma levels for secondary stroke prevention

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider