Practice Preferences on Dabigatran and Rivaroxaban for Stroke Prevention in Patients with Non-valvular Atrial Fibrillation

OBJECTIVE: Prescription rate of dabigatran and rivaroxaban, which are the direct oral anticoagulants (DOAC), has increased. We have analyzed the prescription trend and medication use of dabigatran and rivaroxaban in patients with non-valvular atrial fibrillation (NVAF). METHODS: It was retrospectively studied from September 2012 to April 2014 using the electronic medical records and the progress notes. Patients with NVAF (n=424) were evaluated on the medication use, prescribing preferences, adverse drug reactions (ADRs) and the availability of prescription reimbursement of dabigatran (n=210) and rivaroxaban (n=214). RESULTS: Dabigatran was prescribed higher than rivaroxaban (23.3% versus 7.5%, p<0.001) in the neurology department, but rivaroxaban was prescribed higher compared to dabigatran in the cardiology department (87.4% versus 74.3%, p<0.001). Dabigatran was prescribed more than rivaroxaban in high risk patients with CHADS2 score ≥ 3 (44.3% versus 31.3%, p=0.006). Dabigatran patients seemed to have more ADRs than patients with rivaroxaban (25.2% versus 11.2%, p<0.001), but no serious thrombotic events and bleeding were found. Only 35.6% (n=151) were eligible for prescription reimbursement by the National Health Insurance (NHI). Bridging therapy (86, 31.5%) and direct-current cardioversion (57, 20.2%) were main reasons of ineligibility for reimbursement. CONCLUSION: Prescription preferences were present in choosing either dabigatran or rivaroxaban for patients with NVAF. Inpatient protocols and procedures considering patient-factors in NVAF need to be developed.

Body Composition of Children and Adolescents with Insulin-dependent Diabetes Mellitus

Bodycomposition measurement is useful in the diagnosis of pathology, assessment of disease process and response to treatement in many endoclonologic and metabolic diseases. The Techniques used currently are mostly indirect, often expensive, difficult and time-consuming. A new method for estimation of body composition, infrared interactance, is rapid, safe, noninvasive, and may be useful in research and clinical studies. Body composition was assessed in 51 children and adolescants with insulin-dependent diabetes mellitus by infrared interactance method using a Futrex 5000A body fat content analyzer. Percentage body fat of pubertal girls was 26.1+/-7.6%, significantly greater than prepubertal girls (17.9%, 0<0.01) and pubertal boys (19.9%, p<0.05). Body fat content was increased through puberty in girls. but not increased in boys. Our data do not explain why body fat of pubertal boys was not increased. There was no significant association of insulin dose and HbA1C level with percentage body fat. Thus, we had to attempt measure calorie intake, activity level and diet composition. Our data revealed that dietary carbohydrates may prompt fat deposition, but energy balance does not explain the differences between pubertal girls and boys. In conclusion, Body fat increased through puberty in girls, but the etiology of differences in pubertal girls and boys is not clear, and in view of potential adverse effect of fat depostion of long-term health, further larger case-contolled study will be necessary.