Introduction

Direct oral anticoagulants (DOACs) are effective drugs in the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). The correct dosage of these drugs contributes to a reduction in the recurrence of stroke and hemorrhagic complications.

Goals

To assess the percentage of patients receiving the correct dose of DOACs after an ischemic stroke or TIA. To detect factors involved in an incorrect dosage of these drugs.

Method

Retrospective analysis of consecutive patients admitted to our stroke unit during a period of 5 years with a diagnosis of NVAF, and for whom treatment with DAA was prescribed. Demographic and vascular risk factors, previous treatments, clinical parameters and hemorrhagic risk, type of  DOACs and dose at discharge were evaluated. Statistical analysis: t-Student, Mann-Whitney U, chi-square and logistic regression analysis.

Results

341 patients were included in the study (mean age 74.96 ± 9.13 years, 60.4% males). 62 patients (18.2%) received doses of DOACs lower than those indicated and 8 patients (2.3%) were treated with doses higher than those indicated.

The factors related to the underdosing of the DOACs  were the high age (OR 1.257; 95% CI 1.018-1.551; p = 0.034), the concomitant treatment with antiplatelet agents (OR 4.997; 95% CI 2.171-11.502; p <0.001) and presenting a filtrate glomerular <50 ml/min/1,73 m2 and/or creatinine> 1.5 mg / dl (OR 0.111; 95% CI 0.014-0.895; p = 0.039). 


Conclusions

Approximately 20% of our patients received an incorrect dose of DOACs. This could contribute to an increase in the recurrence  of acute cerebrovascular disease and  increase the risk of hemorrhagic complications.

DIRECT ORAL ANTICOAGULANTS AFTER STROKE: ARE OUR PATIENTS CORRECTLY TREATED?