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Impact of dabigatran dose on drug levels in asian patients with atrial fibrillation or venous thromboembolism: evidence from pharmacological to clinical outcomes

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Abstract

Dabigatran is commonly used in atrial fibrillation (AF) or venous thromboembolism (VTE). However, there was limited data on dabigatran levels in Asian patients. This study aimed to investigate plasma levels of dabigatran 110 mg (D110) or 150 mg (D150) twice daily and their impact on clinical outcomes in Thai patients. This was a prospective cohort study including patients who were diagnosed with AF or VTE and were prescribed either D110 or D150. Plasma dabigatran levels were measured using the diluted thrombin time method. All patients were observed for bleeding and thrombotic complications for 12 months after enrollment. Ninety patients were included in the study (45 in the D110 group and 45 in the D150 group). For the D110 group, there was no significant difference in trough and peak levels in patients with creatinine clearance (CrCl) < 50 ml/min compared to those with CrCl ≥ 50 ml/min. For the D150 group, patients with CrCl < 50 ml/min had significantly higher trough and peak levels compared to those with CrCl ≥ 50 ml/min (P = 0.016 for trough, P = 0.005 for peak). Multivariate regression analysis showed females and low CrCl were independent risk factors for high dabigatran levels. Most patients (83.33%) who experienced bleeding complications had peak levels within the expected range. D150 was associated with higher plasma dabigatran levels, especially in those with impaired renal function.

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Acknowledgements

We acknowledge the laboratory support from the Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University.

Funding

This work was supported by grants from the Faculty of Medicine Research Fund, grant no. 147–2563, Chiang Mai University, Thailand.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Nonthakorn Hantrakun, Lalita Norasetthada, Adisak Tantiworawit, Ekarat Rattarittamrong, Thanawat Rattanathammethee, Sasinee Hantrakool, Pokpong Piriyakhuntorn, Teerachat Punnachet, Piangrawee Niprapan & Chatree Chai-Adisaksopha

  2. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Wanwarang Wongcharoen

  3. Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Kitti Thiankhaw

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  1. Nonthakorn Hantrakun
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Correspondence to Chatree Chai-Adisaksopha.

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Hantrakun, N., Wongcharoen, W., Thiankhaw, K. et al. Impact of dabigatran dose on drug levels in asian patients with atrial fibrillation or venous thromboembolism: evidence from pharmacological to clinical outcomes. J Thromb Thrombolysis 55, 392–398 (2023). https://doi.org/10.1007/s11239-022-02747-w

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