Journal of Nakornping Hospital

Comparison of the safety of dabigatran and rivaroxaban in Thai patients: A single-center retrospective study

Warunsorn Krintratun — 2026-03-09

Introduction: Direct oral anticoagulants (DOACs), such as dabigatran and rivaroxaban, are commonly used for stroke prevention in atrial fibrillation and venous thromboembolism treatment. However, real-world data on their comparative safety profiles in Thai population is limited.

Objective: The primary objective was to compare the safety outcomes of dabigatran and rivaroxaban in Thai population in real-world use.

Methods: This retrospective cohort study was conducted at Chiangrai Prachanukroh Hospital. The study included patients age over 18 years, diagnosed with AF or VTE, and received either dabigatran or rivaroxaban. Data were collected via electronic medical records from 1 January 2015 to 30 September 2023. Baseline characteristics, bleeding events, and thrombotic outcomes were analyzed.

Results: Total 249 patients were included. The study population’s mean age was 70.5 ± 10.2 years, with 51% being male. The median follow-up time was 17.5 months
(IQR, 11 - 31 months) for both groups. Dabigatran was prescribed more frequently to patients with a history of stroke compared to rivaroxaban (55.0% vs. 16.4%, p < 0.001). Conversely, rivaroxaban was prescribed more often to patients with heart failure (23.1% vs. 13.1%, p = 0.025). The dabigatran group had a higher HAS-BLED and CHA₂DS₂-VASc scores compared to the rivaroxaban group (1.9 vs. 1.5, p < 0.001, and 3.8 vs 3.2, p = 0.001), respectively. The incidence of major and clinically relevant non-major bleeding was 3.34 and 3.86 per 100 person-years for rivaroxaban and dabigatran, respectively (HR 1.15, 95% CI: 0.44 - 3.04, p = 0.774). No intracranial bleeding was observed in either group.

Conclusion: This study found no significant difference in the risk of major or clinically relevant non-major bleeding between dabigatran and rivaroxaban in Thai population. Further large-scale studies are warranted to confirm these findings and to guide clinical decision-making.

Prevalence and factors associated with high-risk opioid prescribing among cancer patients receiving palliative care at a community hospital

Thitichaya Penthinapong — 2026-03-09

Introduction: As the demand for palliative and oncological care continues to increase, opioids remain a cornerstone of symptoms and pain management in patients with advanced cancer. However, evidence on opioid prescribing patterns in these care settings, particularly within community hospitals, remains limited, and systematic evaluation is needed to support safe and effective clinical practice.

Objective: This study aimed to evaluate opioid prescribing patterns and the prevalence of high-risk opioid prescribing among patients with cancer receiving palliative care at Sanpatong Hospital.

Methods: This retrospective study reviewed electronic medical records of palliative cancer patients aged ≥ 20 years who received opioids during the final six months of life without concurrent anticancer treatment between 2018 and 2023. Patients were identified using ICD-10 codes Z51.5 (palliative care) and Z71.4 (other specified counseling) at Sanpatong Hospital. High-risk opioid prescribing was defined by opioid prescribing patterns calculated as morphine milligram equivalents (MME) and concomitant medication use, including opioid–benzodiazepine co-prescription, high-dose opioid therapy (≥ 90 MME/day for ≥ 7 days), or specific initial prescribing characteristics.

Results: Among 44 patients, 36 patients (81.8%) met high-risk criteria, with prolonged initial opioid prescribing observed in 35 patients (97.2%) and initial prescribing of long-acting opioid formulations in 30 patients (83.3%). Median daily MME was significantly higher in the high-risk group than in the low-risk group (20 vs. 4 mg/day, p = 0.004). No significant associations were found between high-risk of opioid-related problems and palliative performance status, adjuvant analgesic use, or tetrahydrocannabinol co-prescription.

Conclusion: High-risk opioid prescribing was commonly observed among hospice palliative care patients in a community hospital. These findings demonstrate the need for balanced opioid prescribing practices and enhanced monitoring in community-based palliative care to mitigate potential opioid-related harm.

Associated factors of potentially inappropriate medications use in elderly patients at the Family Medicine Clinic, Nakornping Hospital

Pimsiri Chantaboon — 2026-03-09

Introduction: Potentially inappropriate medications (PIMs) use in older adults is an important issue worldwide, as older patients commonly have multiple comorbidities, receive several medications, and increased risk of adverse drug reactions and drug–drug interactions.

Objective: To identify associated factors of potentially inappropriate medications used in elderly patients at the Family Medicine Clinic, Nakornping Hospital Chiang Mai.

Methods: This cross-sectional study included all patients aged ≥60 years who received at least one prescribed medication from the Family Medicine Clinic at Nakornping Hospital between 1 January and 31 August 2024. Data were obtained from electronic medical records, including demographics, comorbidities, insurance type, prescription details, and laboratory results. PIMs were classified according to the 2023 AGS Beers Criteria. Factors associated with PIM use were analyzed using multiple logistic regression.

Results: Among 134 participants (60.45% female; mean age 71.61 ± 8.56 years), 74.63% had universal coverage insurance, 69.40% had polypharmacy, and 53.73% had ≥2 comorbidities. Overall, 104 (77.61%) received at least one PIMs. Significant factors associated with PIMs use were receipt of ≥ 5 medications (aOR 5.91, 95% CI 1.57–22.27), universal coverage health insurance (adjusted OR 4.83, 95% CI 1.60–14.57), and musculoskeletal disease (adjusted OR 6.98, 95% CI 1.94–25.08). The five most frequently prescribed PIMs were orphenadrine, omeprazole, naproxen, lorazepam, and aspirin, respectively.

Conclusion: PIMs used among older adults in this setting was high. Universal coverage health insurance, polypharmacy (≥ 5 medications), and musculoskeletal disease were significantly associated with PIMs use.

Incidence and factors associated with rapid decline in glomerular filtration rate among well-controlled diabetic patients with declining kidney function at Nakornping Hospital

Amonrat Duangmano — 2026-03-09

Introduction: Diabetes mellitus can lead to rapid decline in renal function despite adequate glycemic control. However, information concerning the incidence and determinants of rapid estimated glomerular filtration rate (eGFR) decline in these patients in Thailand remain limited.

Objective: To explore the incidence and factors associated with rapid eGFR decline among patients with well controlled diabetes mellitus with decline of eGFR at Nakornping Hospital.

Methods: This retrospective cohort study utilized electronic medical records and laboratory databases from Nakornping hospital. This study included diabetic patients aged ≥ 35 years with HbA1c <7% and at least two eGFR measurements at least 1 year apart that showed a downward trend between October 1, 2020, and December 31, 2024. Rapid eGFR decline was defined as a decrease in eGFR of more than 5 ml/min/1.73 m² per year, according to KDIGO 2012. Incidence rates per 100 person years were calculated, and data were analyzed using descriptive statistics and multivariable logistic regression.

Results: Among 375 diabetic patients with well-controlled glycemia and declining eGFR, 293 were identified with rapid eGFR decline (median age 66 years, IQR 59–72; 50.17% female), while 82 were in the non-rapid decline group (median age 62 years, IQR 56–69; 59.76% female). The incidence rate of rapid eGFR decline was 59.1 per 100 person-years (95% CI: 52.7–66.3), with a median follow-up duration of 1.3 years (IQR 1.1–1.6). Multivariable analysis revealed that age ≥ 60 years (aOR 2.23; 95% CI 1.26–3.96) and systolic blood pressure ≥140 mmHg (aOR 1.84; 95% CI 1.01–3.34) were significantly associated with rapid eGFR decline. Conversely, higher hemoglobin and HDL cholesterol levels served as protective factors against rapid eGFR decline (aOR 0.83; 95% CI 0.70–0.99 and aOR 0.97; 95% CI 0.95–0.99, respectively).

Conclusion: Diabetic patients with well-controlled glycemia still exhibited a high incidence rate of rapid eGFR decline, particularly among the elderly and those with high systolic blood pressure. The results of this study confirm the importance of blood pressure control, as well as the management of anemia and HDL cholesterol levels, in conjunction with glycemic control for maximum efficacy in slowing the progression of kidney function decline in this patient group.

Associated factors for critical illness and mortality in chronic kidney disease patients admitted with COVID-19 at Nakornping Hospital

Piched Pipatsamut — 2026-03-14

Introduction: Chronic kidney disease (CKD) is an important risk factor for severe coronavirus disease 2019 (COVID-19). Patients with CKD have a higher risk of hospitalization, critical illness, and death compared with the general population. However, data on factors that predict severe disease and mortality specifically in patients with moderate-to-advanced CKD are still limited, especially in real-world clinical settings.

Objective: This study aims to identify clinical and laboratory factors associated with progression to critical illness or in-hospital mortality among patients with stage 3–4 CKD hospitalized for COVID-19 at Nakornping Hospital.

Methods: This retrospective cohort study was conducted at Nakornping Hospital. We reviewed electronic medical records of adult patients with stage 3-4 CKD who were admitted with confirmed COVID-19 between March 2020 and 2022. Baseline demographic data, comorbidities, and laboratory results at hospital admission were collected. The primary outcome was a composite of critical illness or in-hospital death. Multivariate logistic regression analysis was used to identify independent factors associated with the primary outcome.

Results: A total of 128 in-patients with stage 3–4 CKD and COVID-19 were included; 48 patients (37.5%) had mild-to-moderate disease, while 80 patients (62.5%) developed critical illness or died during hospitalization. Advanced age (> 80 years) was significantly associated with a higher risk of critical illness or death (OR 3.13, 95% CI 1.14-8.61, p = 0.027) and also patients with stage IV CKD (OR 2.56, 95% CI 1.20-5.42, p = 0.014), elevated white blood cell count (> 10,000/μL) (OR 2.75, 95% CI 1.23-6.16, p = 0.014), elevated sodium levels (OR 8.71, 95% CI 1.09-19.93, p=0.042), increased C-reactive protein (OR 1.00 95% CI 1.00-1.01, p < 0.001), lower serum albumin levels (OR 1.37, 95% CI 1.06-1.77, p=0.015), and elevated serum lactate levels (OR 5.93 95% CI 1.65-21.32, p = 0.013). Sex, diabetes mellitus, hypertension, and prior COVID-19 vaccination were not significantly associated with the primary outcome. After adjusted for laboratory variables, only WBC > 10,000/μL and lactate > 3 mmol/L had been significantly associated with higher risk of critical illness or death (AOR 4.70, 95% CI 1.51-14.61, p= 0.008 and AOR 9.36, 95% CI 2.13-41.06, p= 0.003).

The effect of motivational interviewing–based health behavior counseling on lipid control among patients with hyperlipidemia

Butchaya Sansee — 2026-03-14

Introduction: Hyperlipidemia is a major modifiable risk factor, and behavioral modification is essential in its management. Motivational interviewing (MI) has been shown in several studies to improve lipid control and reduce cardiovascular disease risk. However, evidence in the context of primary care in Thailand remains limited.

Objective: To evaluate the effect of motivational interviewing–based health behavior counseling, compared with standard care, on changes in blood lipid levels and cardiovascular risk scores among participants.

Methods: A prospective, non-randomize systematic allocation trial was conducted among patients who had abnormal lipid profiles or were at high risk for cardiovascular events attending the Family Medicine Outpatient Department at Nakornping Hospital between 2024 and 2025. The intervention group received motivational interviewing sessions, whereas the control group received standard care. Both groups were followed up at 3 months. Differences in means or proportions between and within groups were analyzed using multiple logistic regression, adjusting for important covariates.

Results: A total of 50 patients were enrolled, with 25 patients allocated to the intervention group (male 36%, mean age 59.44 ± 11.97 years) and 25 patients to the control group (male 36%, mean age 65.40 ± 9.83 years). After 3-month follow-up, both groups showed statistically significant reductions in mean total cholesterol and LDL‑cholesterol levels compared with baseline. The mean changes in total cholesterol were -21.24 mg/dL (95% CI -44.10 to 1.62) in the intervention group and -7.88 mg/dL (95% CI -25.94 to 10.18) in the control group, while the corresponding changes in LDL-cholesterol were -25.12 mg/dL (95% CI -49.54 to -0.70) and -7.56 mg/dL (95% CI -26.05 to 10.93), respectively. However, multivariable logistic regression adjusting for baseline characteristics demonstrated no statistically significant differences between groups. Triglycerides, HDL‑cholesterol, and cardiovascular risk scores tended to improve in both groups, but these changes did not reach statistical significance. In contrast, the intervention group showed a significantly greater increase in knowledge and awareness scores than the control group (mean difference 4.16, 95% CI 3.28–5.04, p < 0.001).

Conclusion: Motivational interviewing helped reduce LDL cholesterol and showed a trend toward improving overall lipid profiles, despite no significant differences in other indicators. Integrating this technique with standard care may support better lipid control and lower long term cardiovascular risk.