1. Estimating the Quantitative Demand of NOAC Antidote Doses on Stroke Units
- Author
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Thorsten Steiner, Anke Reihs, Helmuth Steinmetz, Christian Foerch, Waltraud Pfeilschifter, Benno Ikenberg, Adam Strzelczyk, Mario Abruscato, Tobias Neumann-Haefelin, Daniela Niemann, Günther Hedtmann, Andreas Ferbert, Dana Farahmand, Sven Thonke, Rainer Kollmar, Oliver C. Singer, Carina Hohmann, and Björn Misselwitz
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_mechanism_of_action ,medicine.medical_treatment ,Antidotes ,Factor Xa Inhibitor ,Administration, Oral ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Germany ,medicine ,Humans ,Thrombolytic Therapy ,Registries ,cardiovascular diseases ,Antidote ,Stroke ,Antithrombins ,Aged ,Cerebral Hemorrhage ,Aged, 80 and over ,Health Services Needs and Demand ,business.industry ,Anticoagulants ,Stroke units ,Middle Aged ,medicine.disease ,Neurology ,Anesthesia ,Emergency medicine ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Hospital Units ,Needs Assessment ,030217 neurology & neurosurgery ,Forecasting - Abstract
Background: The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit. Methods: We extracted data of patients with acute ischemic stroke and ICH (Results: Eighteen percent of ICH patients within 6 h of symptom onset or an unknown symptom onset were on OAT. Given a NOAC share at admission of 40%, about 7% of all ICH patients may qualify for NOAC reversal therapy. Thirteen percent of ischemic stroke patients admitted within 4 h presented on anticoagulation. Given the availability of an appropriate antidote, a NOAC share of 50% could lead to a 6.1% increase in thrombolysis rate. Conclusions: Stroke units serving populations with a comparable demographic structure should prepare to treat up to 1% of all acute ischemic stroke patients and 7% of all acute ICH patients with NOAC antidotes. These numbers may increase with the mounting prevalence of atrial fibrillation and an increasing use of NOAC.
- Published
- 2016