Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Practice Preferences on Dabigatran and Rivaroxaban for Stroke Prevention in Patients with Non-valvular Atrial Fibrillation

비판막성 심방세동 환자의 뇌졸중 예방에서 dabigatran과 rivaroxaban의 임상적용의 현황

  • Park, You Kyung (Department of Pharmacy, Seoul St. Mary's Hospital) ;
  • Kang, Ji Eun (College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University) ;
  • Kim, Seong Joon (Albany College of Pharmacy and Health Sciences) ;
  • La, Hyen O (Department of Pharmacology, School of Medicine, The Catholic University of Korea) ;
  • Rhie, Sandy Jeong (Graduate School of Clinical Health Sciences, Ewha Womans University)
  • 박유경 (서울성모병원 약제부) ;
  • 강지은 (이화여자대학교 약학대학 생명약학부) ;
  • 김승준 (알바니 약학대학) ;
  • 라현오 (가톨릭대학교 의과대학) ;
  • 이정연 (이화여자대학교 임상보건과학대학원)
  • Received : 2016.04.28
  • Accepted : 2016.08.16
  • Published : 2016.09.30
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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 ${\geq}3$ (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.

Keywords

References

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