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Cao C, Xu Y, Jiang W, Wu S, Shen Y, Xia X, Wang L, Zhang H, Jiang H, Li X, Li X, Ye Y. Nomogram for predicting bleeding events in nonvalvular atrial fibrillation patients receiving rivaroxaban: A retrospective study. Health Sci Rep 2024; 7:e1792. [PMID: 38196572 PMCID: PMC10774492 DOI: 10.1002/hsr2.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024] Open
Abstract
Background and Aims To construct a bleeding events prediction model of nonvalvular atrial fibrillation (NVAF) patients receiving rivaroxaban. Methods We conducted a retrospective cohort study in patients with NVAF who received rivaroxaban from June 2017 to March 2019. Demographic information and clinical characteristics were obtained from the electronic medical system. Univariate analysis was used to find the primary predictive factors of bleeding events in patients receiving rivaroxaban. Multiple analysis was conducted to screen the primary independent predictive factors selected from the univariate analysis. Finally, the independent influencing factors were applied to build a prediction model by using R software; then, a nomogram was established according to the selected variables visually, and the sensitivity and specificity of the model was evaluated. Results Twelve primary predictive factors were selected by univariate analysis from 46 variables, and multivariate analysis showed that older age, higher prothrombin time (PT) values, history of heart failure and stroke were independent risk factors of bleeding events. The area under curve (AUC) for this novel nomogram model was 0.828 (95% CI: 0.763-0.894). The mean AUC over 10-fold stratified cross-validation was 0.787, and subgroup analysis validation also showed a satisfied AUC. In addition, the decision curve analysis showed that the PT in combination with CHA2DS2-VASc and HASBLED was more practical and accurate for predicting bleeding events than using CHA2DS2-VASc and HASBLED alone. Conclusions PT in combination with CHA2DS2-VASc and HASBLED could be considered as a more practical and accurate method for predicting bleeding events in patients taking rivaroxaban.
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Affiliation(s)
- Chang Cao
- Department of Pharmacy, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Yijiao Xu
- Department of Respiration, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
| | - Weiwen Jiang
- Department of Pharmacy, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Shujing Wu
- Department of Cardiology, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
| | - Yun Shen
- Department of Pharmacy, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Xiaotong Xia
- Department of Pharmacy, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
| | - Lumin Wang
- Department of Pharmacy, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
| | - Huijun Zhang
- Department of Respiration, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
| | - Hongni Jiang
- Department of Respiration, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Xiaoye Li
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Yanrong Ye
- Department of Pharmacy, Zhongshan Hospital (Xiamen)Fudan UniversityXiamenChina
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
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Ng J, Mohd Tahir NA, Chin PKL, Makmor‐Bakry M, Mohd Saffian S. A systematic review and meta‐analysis of dabigatran peak and trough concentration in adults. Br J Clin Pharmacol 2022; 88:4443-4459. [DOI: 10.1111/bcp.15431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/30/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jia‐Wei Ng
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz Kuala Lumpur Malaysia
| | - Nor Asyikin Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz Kuala Lumpur Malaysia
| | - Paul K. L. Chin
- Department of Medicine University of Otago Christchurch New Zealand
- Department of Clinical Pharmacology, Christchurch Hospital Christchurch New Zealand
| | - Mohd Makmor‐Bakry
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz Kuala Lumpur Malaysia
| | - Shamin Mohd Saffian
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz Kuala Lumpur Malaysia
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Gutiérrez-Zúñiga R, Rigual R, Torres-Iglesias G, Sánchez-Velasco S, Alonso de Leciñana M, Masjuan J, Álvarez Velasco R, Navas I, Izquierdo-Esteban L, Fernández-Ferro J, Rodríguez-Pardo J, Ruiz-Ares G, Zapata-Wainberg G, Fuentes B, Díez-Tejedor E. Long-Term Anticoagulation in Secondary Ischemic Stroke Prevention: The Prospective Multicenter RESTAIC Registry. Front Neurol 2020; 11:575634. [PMID: 33193025 PMCID: PMC7641639 DOI: 10.3389/fneur.2020.575634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Oral anticoagulation (OAC) for secondary stroke prevention is recommended in atrial fibrillation (AF) and other sources of cardioembolic stroke. Our objectives were to explore the differences in ischemic and hemorrhagic events when using OAC for secondary stroke prevention according to the type of anticoagulant treatment and to analyze the number and reasons for OAC switches during long-term follow-up. Methods: Ischemic stroke (IS) patients who were discharged on OAC for secondary stroke prevention from January 2014 to October 2017 were recruited in a prospective, multicenter, hospital-based registry. Follow-up at 3 months was scheduled at the outpatient clinic with subsequent annual phone interviews for 3 years. Patients were classified into three study groups according to OAC at discharge: Vitamin K antagonist (VKA), Factor Xa inhibitor (FXa), or direct thrombin inhibitor (DTI). We compared stroke recurrences, intracranial hemorrhage, major bleeding, and all-cause mortality during the follow-up. We recorded any switches in OAC and the main reasons for the change. Results: A total of 241 patients were included. An anticoagulant was indicated in the presence of a source of cardioembolic stroke in 240 patients (99.6%) and lupus plus antiphospholipid syndrome in one patient. Up to 86 patients (35.6%) were on OAC before the index stroke; in 71 (82.5%) of them, this was VKA. At hospital discharge, 105 were treated with FXa (43.8%), 96 with VKA (39.6%), and 40 with DTI (16.6%). The cumulative incidences at 3 years were 17% for stroke recurrence, 1.6% for intracranial hemorrhage, 4.9% for major hemorrhage, and 22.8% for all-cause mortality, with no differences among the OAC groups in any outcomes. During the follow-up, 40 OAC switches were recorded (63% of them to FXa), mostly due to stroke recurrence. Conclusion: Long-term OAC in secondary stroke prevention is associated with a lower frequency of bleeding complications than stroke recurrences. No differences between anticoagulant drugs were found in any of the analyzed outcomes. The main cause for OAC switch during follow-up was stroke recurrence.
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Affiliation(s)
- Raquel Gutiérrez-Zúñiga
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ricardo Rigual
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gabriel Torres-Iglesias
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sara Sánchez-Velasco
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Alonso de Leciñana
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jaime Masjuan
- Departamento de Medicina, Facultad de Medicina, Servicio de Neurología, H Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Rodrigo Álvarez Velasco
- Departamento de Medicina, Facultad de Medicina, Servicio de Neurología, H Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Inmaculada Navas
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - José Fernández-Ferro
- Neurology Department and Stroke Unit, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Jorge Rodríguez-Pardo
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gerardo Ruiz-Ares
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Blanca Fuentes
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Neurology Department and Stroke Centre, Hospital La Paz Institute for Heath Research-IdiPAZ, La Paz Univerisity Hospital, Universidad Autónoma de Madrid, Madrid, Spain
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Cho HJ, Kang YJ, Sung SM, Ahn SH, Jung YH, Lee KY, Seo JH, Han SW, Park JH, Choi HY, Kwon JH, Kim WJ, Park HJ, Choi JK, Nam HS, Heo JH, Kim YD. Effects of dabigatran and rivaroxaban on stroke severity according to the results of routine coagulation tests. PLoS One 2020; 15:e0240483. [PMID: 33044991 PMCID: PMC7549802 DOI: 10.1371/journal.pone.0240483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/25/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Prior use of direct oral anticoagulants has been associated with reduced stroke severity in patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to investigate the impact of prothrombin time (PT) and activated partial thromboplastin time (aPTT) on stroke severity in patients who were receiving dabigatran or rivaroxaban at the time of stroke onset. Materials and methods We enrolled 107 patients with NVAF who developed acute ischemic stroke while on dabigatran or rivaroxaban and presented within 24 hours to nine hospitals between January 2014 and December 2018. The results of PT and aPTT assays were obtained within 24 hours of stroke onset in all patients. We analyzed PT and aPTT in relation to stroke severity and ischemic lesion volume using correlation and multivariable regression analyses. Results Of the 107 patients included, 46 (43.0%) were on dabigatran and 61 (57.0%) were on rivaroxaban. In patients with prior dabigatran use, while aPTT was inversely correlated with admission National Institutes of Health Stroke Scale (NIHSS) score (r = -0.369, p = 0.012) and ischemic lesion volume (r = -0.480, p = 0.005), there was no correlation between PT and either of these variables. Multivariable analysis confirmed the existence of a significant independent inverse relationship between aPTT and NIHSS score at admission (B, -0.201; 95% confidence interval [CI], -0.370 to -0.032; p = 0.005) and between aPTT and ischemic lesion volume (B, -0.076; 95% CI, -0.130 to -0.023; p = 0.007). In patients with prior rivaroxaban use, neither PT nor aPTT was associated with admission NIHSS score or ischemic lesion volume in the correlation and multivariable analyses. Conclusions In patients with NVAF who were receiving dabigatran, prolonged aPTT was associated with reduced stroke severity.
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Affiliation(s)
- Han-Jin Cho
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Yoon Jung Kang
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Sang Min Sung
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Sung-Ho Ahn
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yo Han Jung
- Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hwa Seo
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Won Han
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Joong Hyun Park
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Hyung Jong Park
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Kyo Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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