TY  - JOUR
A1  - Tütüncü, Serdar
A1  - Olma, Manuel
A1  - Kunze, Claudia
A1  - Dietzel, Joanna
A1  - Schurig, Johannes
A1  - Fiessler, Cornelia
A1  - Malsch, Carolin
A1  - Haas, Tobias Eberhard
A1  - Dimitrijeski, Boris
A1  - Doehner, Wolfram
A1  - Hagemann, Georg
A1  - Hamilton, Frank
A1  - Honermann, Martin
A1  - Jungehulsing, Gerhard Jan
A1  - Kauert, Andreas
A1  - Koennecke, Hans-Christian
A1  - Mackert, Bruno-Marcel
A1  - Nabavi, Darius
A1  - Nolte, Christian H.
A1  - Reis, Joschua Mirko
A1  - Schmehl, Ingo
A1  - Sparenberg, Paul
A1  - Stingele, Robert
A1  - Völzke, Enrico
A1  - Waldschmidt, Carolin
A1  - Zeise-Wehry, Daniel
A1  - Heuschmann, Peter U.
A1  - Endress, Matthias
A1  - Haeusler, Karl Georg
T1  - Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry
JF  - Journal of Neurology
N2  - Aims
We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke.
Methods
The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke.
Results
At stroke onset, an off-label daily dose was prescribed in 61 (25.5%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2%) of 61 patients. Overall, 79 (13.7%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95% CI 1.28-2.84, P < 0.01].
Conclusion
At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge.
KW  - NOAC
KW  - ischemic stroke
KW  - atrial fibrillation
KW  - under-dosing
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266969
SN  - 1432-1459
VL  - 269
IS  - 1
ER  - 
TY  - JOUR
A1  - Scheitz, Jan F.
A1  - Lim, Jess
A1  - Broersen, Leonie H. A.
A1  - Ganeshan, Ramanan
A1  - Huo, Shufan
A1  - Sperber, Pia S.
A1  - Piper, Sophie K.
A1  - Heuschmann, Peter U.
A1  - Audebert, Heinrich J.
A1  - Nolte, Christian H.
A1  - Siegerink, Bob
A1  - Endres, Matthias
A1  - Liman, Thomas G.
T1  - High‐Sensitivity Cardiac Troponin T and Recurrent Vascular Events After First Ischemic Stroke
JF  - Journal of the American Heart Association
N2  - Background
Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of high‐sensitivity cardiac troponin T (hs‐cTnT) are associated with recurrent vascular events and death in patients with first‐ever, mild to moderate ischemic stroke.

Methods and Results
We used data from the PROSCIS‐B (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hs‐cTnT levels upon study entry (Roche Elecsys, upper reference limit, 14 ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and all‐cause death). A total of 562 patients were analyzed (mean age, 67 years [SD 13]; 38.6% women; median National Institutes of Health Stroke Scale=2; hs‐cTnT above upper reference limit, 39.2%). During a mean follow‐up of 3 years, the primary outcome occurred in 89 patients (15.8%), including 40 (7.1%) recurrent strokes, 4 (0.7%) myocardial infarctions, and 51 (9.1%) events of all‐cause death. The primary outcome occurred more often in patients with hs‐cTnT above the upper reference limit (27.3% versus 10.2%; adjusted hazard ratio, 2.0; 95% CI, 1.3–3.3), with a dose‐response relationship when the highest and lowest hs‐cTnT quartiles were compared (15.2 versus 1.8 events per 100 person‐years; adjusted hazard ratio, 4.8; 95% CI, 1.9–11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex.

Conclusions
Hs‐cTnT is dose‐dependently associated with an increased risk of recurrent vascular events and death within 3 years after first‐ever, mild to moderate ischemic stroke. These findings support further studies of the utility of hs‐cTnT for individualized risk stratification after stroke.
KW  - epidemiology
KW  - ischemic stroke
KW  - mortality/survival
KW  - troponin
KW  - vascular disease
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239039
VL  - 10
IS  - 10
ER  -