Adherence to anticoagulant treatment with apixaban and rivaroxaban in a real-world setting

Al‐Khalili, Faris; Lindström, Catrine; Benson, Lina

doi:10.1016/j.ctrsc.2016.03.003

Cited by 19 publications

(25 citation statements)

References 11 publications

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“…Treatment gaps were rare, patients generally having enough medication to cover the treatment period; median medication refill adherence, and compliance rate during the first 6 months of treatment, indicated oversupply rather than undersupply of drugs, although these findings might be due to the timing of prescriptions. High median adherence to DOAC treatment has been shown before: between 94% and 99.7% for dabigatran and up to 100% for rivaroxaban and apixaban . Results differ however, which might in part be due to distinct methodology, as calculation methods for adherence and analysable time periods varied between studies.…”

Section: Discussionmentioning

confidence: 57%

“…Hence, this study includes measures of both discontinuation/persistence and adherence. Discontinuation has been calculated using the refill‐gap method with censoring of patients after the first discontinuation event, defined as a gap of more than 28 days without supply following the assumed end of a prescription, based on summary statistics of the data and comparable to previous studies . In addition, a second discontinuation rate—allowing for reinitiation of treatment during the study period—has been introduced (cessation rate).…”

Section: Methodsmentioning

confidence: 99%

“…Recently, concerns have been raised about the potential impact of no monitoring and the presence of multimorbidity and polypharmacy on DOAC adherence . Knowledge about patients' adherence to DOACs in real life is however still limited, and studies conducted thus far differ in scale, methodology, and focus …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of direct oral anticoagulants in patients with atrial fibrillation in Scotland: Applying a coherent framework to drug utilisation studies

Mueller

Alvarez-Madrazo

Robertson

et al. 2017

Pharmacoepidemiology and Drug

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PurposeTo report the use of direct oral anticoagulants (DOACs) for stroke prevention in patients with atrial fibrillation in Scotland and advocate the standardisation of drug utilisation research methods.MethodsRetrospective cohort study using linked administrative data. Patients included those with a diagnosis of atrial fibrillation (confirmed in hospital) who received a first prescription for a DOAC (dabigatran, rivaroxaban, or apixaban) from September 2011 to June 2014. Drug utilisation measures included discontinuation, persistence, and adherence.ResultsA total of 5398 patients (mean CHA2DS2‐VASc score 2.98 [SD 1.71], 89.7% with ≥5 concomitant medicines) were treated with DOACs for a median of 228 days (interquartile range 105‐425). Of 35.6% who discontinued DOAC treatment, 11.0% switched to warfarin, and 48.3% reinitiated DOACs. Persistence after 12 and 18 months was 75.9% and 69.8%, respectively. Differences between individual DOACs were observed: Discontinuation rates ranged from 20.4% (apixaban) to 60.6% (dabigatran) and 12 months persistence from 60.1% (dabigatran) to 85.5% (apixaban). Adherence to treatment with all DOACs was good: Overall DOAC median medication refill adherence was 102.9% (interquartile range 88.9%‐115.5%), and 82.3% of patients had a medication refill adherence > 80%.ConclusionsIn Scotland, adherence to DOAC treatment was good, and switching from DOAC to warfarin was low. However, discontinuation and persistence rates were variable—although treatment interruptions were often temporary.To decrease the inconsistencies in drug utilisation methods and facilitate meaningful study comparison, the use of a coherent framework—using a combination of discontinuation, persistence, and adherence—and the standardisation of measurements is advocated.

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Section: Discussionmentioning

confidence: 57%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Use of direct oral anticoagulants in patients with atrial fibrillation in Scotland: Applying a coherent framework to drug utilisation studies

Mueller

Alvarez-Madrazo

Robertson

et al. 2017

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

show abstract

“…Moreover, registry-based studies usually do not provide information about TTR in patients receiving VKAs, and may be biased by undocumented adherence to OAT. However, real-life studies demonstrate a good therapeutic adherence in patients treated with DOACs [93,94] when compared with VKAs [56]. Finally, observational studies conducted in the U.S. and including DA are not generalizable to European patients, because of different doses approved (150 and 110 mg BID in Europe vs 150 and 75 mg BID in the U.S.).…”

Section: Evidence From Real-world Studiesmentioning

confidence: 99%

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

Grisoglio

Brunetti

et al. 2017

European Journal of Internal Medicine

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“…Contrary to Warfarin, for which about 36% of the patients have been shown not taking more than 20% of the planned doses, 56 all NOACs have demonstrated a good therapeutic adherence in over 85% of patients in real world clinical practice. 57,58 This is particularly important in patients with dementia, 59 which are known to poorly adhere to therapy and require additional treatment strategies, involving also caregivers, in order to ensure adequate surveillance of both adherence and side effects. 10,53 In this setting, NOACs should be preferred to warfarin.…”

Section: Knowledge Gaps and Discussionmentioning

confidence: 99%

Anticoagulation therapy in the elderly with non-valvular atrial fibrillation: a double-edged sword

2017

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Prevalence of non-valvular atrial fibrillation is increasing over time. Particularly in elderly population, treatment strategies to reduce the rate of stroke are challenging and still represent an unsolved cultural question. Indeed, the risk of thromboembolism increases in the elderly in parallel with the risk of bleeding. The frequent coexistence of several morbidities, frailty syndrome, polypharmacy, chronic kidney disease and dementia strengthens the perception that risk-benefit ratio of anticoagulant therapy could be unfavorable, and explains why such treatment is underused in the elderly. Recently, the introduction of non-vitamin K oral anticoagulants (NOACs) has allowed us to overcome the large number of limitations imposed by the use of vitamin K antagonists. In this manuscript, the benefits of individual NOACs in comparison with warfarin in elderly patients are reviewed. Targeted studies on complex elderly patients are needed to test usefulness of a geriatric comprehensive assessment, besides the scores addressing risk of thromboembolic and hemorrhagic events. In the meantime, it is mandatory that use of anticoagulant therapy in most elderly people, currently excluded from randomized controlled trials, is prudent and responsible.

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Adherence to anticoagulant treatment with apixaban and rivaroxaban in a real-world setting

Cited by 19 publications

References 11 publications

Use of direct oral anticoagulants in patients with atrial fibrillation in Scotland: Applying a coherent framework to drug utilisation studies

Use of direct oral anticoagulants in patients with atrial fibrillation in Scotland: Applying a coherent framework to drug utilisation studies

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

Anticoagulation therapy in the elderly with non-valvular atrial fibrillation: a double-edged sword

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