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Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Monitoring the use of dabigatran etexilate for stroke prevention: compliance with renal function guidelines

Bryan H. Simpson 1 3 , David M. Reith 2 , Natalie J. Medlicott 1 , Alesha J. Smith 1
+ Author Affiliations
- Author Affiliations

1 School of Pharmacy, University of Otago, Dunedin, New Zealand

2 Otago Medical School, University of Otago, Dunedin, New Zealand

3 Corresponding author. Email: bryan.simpson@postgrad.otago.ac.nz

Journal of Primary Health Care 12(4) 327-334 https://doi.org/10.1071/HC19115
Published: 9 December 2020

Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

Abstract

INTRODUCTION: Dabigatran etexilate has become widely used in New Zealand, but information relating to when renal function monitoring is being undertaken is lacking.

AIM: To investigate if clinically appropriate renal function monitoring is being undertaken in New Zealand primary care for stroke prevention in non-valvular atrial fibrillation patients prescribed dabigatran etexilate.

METHODS: New Zealand non-valvular atrial fibrillation patients’ prescription and primary care health data were extracted from national administrative databases for the period 1 July 2011 to 31 December 2015. The proportion of patients who had serum creatinine measurements at close proximity to treatment initiation and 12-months post initiation were assessed with 95% confidence intervals (CIs) and compared with Fisher’s exact test. Log-rank tests for univariate analysis (gender, age, ethnicity and deprivation) effects on serum creatinine testing at dabigatran etexilate treatment initiation and 12-months post initiation were performed.

RESULTS: Overall, 1,948 patients who had been dispensed dabigatran etexilate with available primary care health data were identified. A total of 1,752 (89.9% [CI: 88.5–91.2]) patients had a renal function test at dabigatran etexilate initiation. There were 929 (72.8% [CI: 70.2–75.2]) patients who received ≥1 year supply of dabigatran etexilate and of these 207 (22.3% [CI: 19.6.6–25.1]) had a serum creatinine test 1 year after initiation. Demographic univariate analysis yielded insignificant log-rank tests for association with having serum creatinine measurements, except for Pacific Peoples.

DISCUSSION: There appears to be sub-optimal adherence to renal function monitoring for non-valvular atrial fibrillation patients who receive more than 12-months’ treatment with dabigatran etexilate in New Zealand primary care.

Keywords: dabigatran etexilate, non-valvular atrial fibrillation, renal function, stroke


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