title: Continuation of dabigatran therapy in "real-world" practice in Hong Kong.
abstract: BACKGROUND
  Dabigatran, an oral direct thrombin inhibitor, possesses several advantages over warfarin that can in principle simplify the management of stroke prevention in atrial fibrillation (AF). Nonetheless it remains unclear whether these advantages can translate to clinical practice and encourage long-term therapy. The objective was to describe long-term dabigatran therapy for stroke prevention in AF and to identify risk factors for discontinuation of therapy.
  
  
  RESULTS
  We studied 467 consecutive Chinese patients (72 ± 11 years, male: 53.8%) with a mean CHA2DS2-VASc score of 3.6 prescribed dabigatran for stroke prevention in AF from March 2010 to September 2013. Over a mean follow-up of 16 months, 101 patients (21.6%) permanently discontinued dabigatran. The mean time-to-discontinuation was 8 months. The most common reason for discontinuation was dyspepsia (30.7%), followed by other adverse events (17.8%) such as minor bleeding (8.9%), major gastrointestinal bleeding (7.9%), and intracranial hemorrhage (1%). Other reasons included dosing frequency (5.9%), fear of side effects (4.0%), lack of laboratory monitoring (1.0%), and cost (1.0%). Multivariable analysis revealed that low baseline estimated glomerular filtration rate (p = 0.02), absence of hypertension (p = 0.01), and prior use of a proton-pump inhibitor (p = 0.02) and H2-receptor blocker (p = 0.01) were independent predictors of drug discontinuation. In addition, there were altogether 9 ischemic strokes (1.5%/years), 3 intracranial hemorrhages (0.5%/year), and 24 major gastrointestinal bleedings (4.1%/year).
  
  
  CONCLUSIONS
  Dabigatran discontinuation is very common amongst Chinese AF patients. This reveals a management gap in the prevention of stroke in AF.
authors.affiliation: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Mei Han
authors.initials: MH
authors.lastname: Ho
authors.affiliation: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Chi Wai
authors.initials: CW
authors.lastname: Ho
authors.affiliation: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cheung
authors.affiliation: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Pak Hei
authors.initials: PH
authors.lastname: Chan
authors.affiliation: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Jo Jo
authors.initials: JJ
authors.lastname: Hai
authors.affiliation: Neurology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Chan
authors.affiliation: Department of Pharmacology and Pharmacy, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Esther W
authors.initials: EW
authors.lastname: Chan
authors.affiliation: Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Gilberto Ka Kit
authors.initials: GK
authors.lastname: Leung
authors.affiliation: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Hung Fat
authors.initials: HF
authors.lastname: Tse
authors.affiliation: Cardiology Division, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong SAR, China.
authors.forename: Chung Wah
authors.initials: CW
authors.lastname: Siu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069604:Dabigatran; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran
references.citation: Int J Cardiol. 2010 Mar 4;139(2):173-80
references.pmid: 19046608
references.citation: Heart. 2007 Apr;93(4):483-7
references.pmid: 17005710
references.citation: Lancet. 2012 Feb 18;379(9816):648-61
references.pmid: 22166900
references.citation: J Thromb Thrombolysis. 2014 Jul;38(1):39-44
references.pmid: 24197653
references.citation: CNS Neurosci Ther. 2012 Dec;18(12):988-93
references.pmid: 23121837
references.citation: Ann Intern Med. 2006 Aug 15;145(4):247-54
references.pmid: 16908915
references.citation: Circulation. 2013 Jul 16;128(3):237-43
references.pmid: 23770747
references.citation: Cerebrovasc Dis. 2004;17(4):303-13
references.pmid: 15026613
references.citation: Ther Adv Neurol Disord. 2014 May;7(3):155-61
references.pmid: 24790645
references.citation: Stroke. 2014 Mar;45(3):e43
references.pmid: 24473183
references.citation: J Hum Hypertens. 2011 May;25(5):304-10
references.pmid: 20596062
references.citation: Heart Rhythm. 2013 Jul;10(7):1082-8
references.pmid: 23501173
references.citation: N Engl J Med. 2009 Sep 17;361(12):1139-51
references.pmid: 19717844
references.citation: Atherosclerosis. 2011 Jul;217(1):292-5
references.pmid: 21513938
references.citation: Stroke. 2003 Sep;34(9):2091-6
references.pmid: 12907817
references.citation: Clin Cardiol. 2012 Dec;35(12):E40-5
references.pmid: 23108916
references.citation: J Cardiovasc Pharmacol. 2011 Jul;58(1):87-90
references.pmid: 21558883
references.citation: Heart Lung Circ. 2013 Jan;22(1):50-5
references.pmid: 23058974
references.citation: JAMA. 2003 Jan 8;289(2):194-202
references.pmid: 12517230
references.citation: Europace. 2010 Oct;12(10):1360-420
references.pmid: 20876603
references.citation: Stroke. 1990 Feb;21(2):230-5
references.pmid: 2305397