한빛사논문
Minji Jung a, Beom-Jin Lee b, Sukhyang Lee c,1, Jaekyu Shin a,1
aDepartment of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA, United States
bResearch Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon, Republic of Korea
cDivision of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea
1These authors contributed equally to the manuscript as the corresponding authors.
Correspondence to: Sukhyang Lee, Jaekyu Shin
Abstract
Introduction: As direct-acting oral anticoagulants (DOACs) have short half-lives of around 12 h, even a short gap in DOAC therapy may diminish anticoagulation effects, increasing risks of adverse clinical outcomes. We aimed to evaluate clinical consequences of a gap in DOAC therapy with atrial fibrillation (AF) and to identify its potential predictors.
Materials and methods: In this retrospective cohort study, we included DOAC users aged over 65 years with AF from the 2018 Korean nationwide claims database. We defined a gap in DOAC therapy as no claim for a DOAC one or more days after the due date of a refill prescription. We used a time-varying-analysis method. The primary outcome was a composite of death and thrombotic events including ischemic stroke/transient ischemic attack or systemic embolism. Potential predictors of a gap included sociodemographic and clinical factors.
Results and conclusions: Among 11,042 DOAC users, 4857 (44.0 %) patients had at least one gap. Standard national health insurance, non-metropolitan locations of medical institutions, history of liver disease, chronic obstructive pulmonary disease, cancer, or dementia, and use of diuretics or non-oral agents were associated with increased risks of a gap. In contrast, history of hypertension, ischemic heart disease, or dyslipidemia were associated with a decreased risk of a gap. A short gap in DOAC therapy was significantly associated with a higher risk of the primary outcome compared to no gap (hazard ratio 4.04, 95 % confidence interval 2.95-5.52). The predictors could be utilized to identify at-risk patients to provide additional support to prevent a gap.
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