Korean J Clin Pharm.
2016 Sep;26(3):207-212. 10.0000/kjcp.2016.26.3.207.
Practice Preferences on Dabigatran and Rivaroxaban for Stroke Prevention in Patients with Non-valvular Atrial Fibrillation
- Affiliations
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- 1Department of Pharmacy, Seoul St. Mary's Hospital, Seoul 06591, Republic of Korea.
- 2Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul 03760, Republic of Korea. sandy.rhie@ewha.ac.kr
- 3College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea.
- 4Albany College of Pharmacy and Health Sciences, Albany, NY 12208, USA.
- 5Department of Pharmacology, School of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
- KMID: 2358236
- DOI: http://doi.org/10.0000/kjcp.2016.26.3.207
Abstract
OBJECTIVE
Prescription rate of dabigatran and rivaroxaban, which are the direct oral anticoagulants (DOAC), has increased. We have analyzed the prescription trend and medication use of dabigatran and rivaroxaban in patients with non-valvular atrial fibrillation (NVAF).
METHODS
It was retrospectively studied from September 2012 to April 2014 using the electronic medical records and the progress notes. Patients with NVAF (n=424) were evaluated on the medication use, prescribing preferences, adverse drug reactions (ADRs) and the availability of prescription reimbursement of dabigatran (n=210) and rivaroxaban (n=214).
RESULTS
Dabigatran was prescribed higher than rivaroxaban (23.3% versus 7.5%, p<0.001) in the neurology department, but rivaroxaban was prescribed higher compared to dabigatran in the cardiology department (87.4% versus 74.3%, p<0.001). Dabigatran was prescribed more than rivaroxaban in high risk patients with CHADS2 score ≥ 3 (44.3% versus 31.3%, p=0.006). Dabigatran patients seemed to have more ADRs than patients with rivaroxaban (25.2% versus 11.2%, p<0.001), but no serious thrombotic events and bleeding were found. Only 35.6% (n=151) were eligible for prescription reimbursement by the National Health Insurance (NHI). Bridging therapy (86, 31.5%) and direct-current cardioversion (57, 20.2%) were main reasons of ineligibility for reimbursement.
CONCLUSION
Prescription preferences were present in choosing either dabigatran or rivaroxaban for patients with NVAF. Inpatient protocols and procedures considering patient-factors in NVAF need to be developed.
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