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@ARTICLE{Ttnc:162787,
      author       = {Tütüncü, Serdar and Olma, Manuel and Kunze, Claudia and
                      Dietzel, Joanna and Schurig, Johannes and Fiessler, Cornelia
                      and Malsch, Carolin and Haas, Tobias Eberhard and
                      Dimitrijeski, Boris and Doehner, Wolfram and Hagemann, Georg
                      and Hamilton, Frank and Honermann, Martin and Jungehulsing,
                      Gerhard Jan and Kauert, Andreas and Koennecke,
                      Hans-Christian and Mackert, Bruno-Marcel and Nabavi, Darius
                      and Nolte, Christian H and Reis, Joschua Mirko and Schmehl,
                      Ingo and Sparenberg, Paul and Stingele, Robert and Völzke,
                      Enrico and Waldschmidt, Carolin and Zeise-Wehry, Daniel and
                      Heuschmann, Peter U and Endres, Matthias and Haeusler, Karl
                      Georg},
      title        = {{O}ff-label-dosing of non-vitamin {K}-dependent oral
                      antagonists in {AF} patients before and after stroke:
                      results of the prospective multicenter {B}erlin {A}trial
                      {F}ibrillation {R}egistry.},
      journal      = {Journal of neurology},
      volume       = {269},
      number       = {1},
      issn         = {0340-5354},
      address      = {Berlin},
      publisher    = {Springer},
      reportid     = {DZNE-2021-01442},
      pages        = {470-480},
      year         = {2022},
      note         = {ISSN 1432-1459 not unique: **2 hits**. (CC BY)},
      abstract     = {We aimed to analyze prevalence and predictors of NOAC
                      off-label under-dosing in AF patients before and after the
                      index stroke.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.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].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.NCT02306824.},
      keywords     = {Administration, Oral / Aged, 80 and over / Anticoagulants:
                      therapeutic use / Atrial Fibrillation: complications /
                      Atrial Fibrillation: drug therapy / Berlin / Brain Ischemia:
                      complications / Brain Ischemia: drug therapy / Humans /
                      Off-Label Use / Prospective Studies / Registries / Stroke:
                      complications / Stroke: drug therapy / Atrial fibrillation
                      (Other) / Ischemic stroke (Other) / NOAC (Other) /
                      Under-dosing (Other)},
      cin          = {AG Endres},
      ddc          = {610},
      cid          = {I:(DE-2719)1811005},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pmc          = {pmc:PMC8739306},
      pubmed       = {pmid:34718884},
      doi          = {10.1007/s00415-021-10866-2},
      url          = {https://pub.dzne.de/record/162787},
}