Comparative Treatment Cost, Effectiveness and Safety of Dabigatran, Rivaroxaban and Warfarin in Atrial Fibrillation (AF) Patients: A Descriptive Study from Penang General Hospital (PGH)

Looi, W.L.; Tan, S.K.; Yeo, HY; Selamat, A. Andin; Hanif, Atisha Abdul; Priyadarshini, C Hepsibah

doi:10.1016/j.ijcard.2017.09.090

Cited by 2 publications

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“…This restriction on NOACs prescribing is likely due to the comparatively high acquisition cost of NOACs, which has been estimated to be around MYR2945 per patient annually for dabigatran and MYR2894 per patient annually for rivaroxaban compared to only MYR651 per patient for warfarin. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

Assessing adherence and persistence to non-vitamin K antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation in tertiary-care referral centers in Malaysia

et al. 2020

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A BSTRACT Introduction: Non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran and rivaroxaban, are now available for stroke prevention in patients with atrial fibrillation (AF) and are often clinically preferred over vitamin K antagonists (VKAs), such as warfarin. Data describing adherence and persistence to NOACs in real-life clinical practice in Malaysia are scarce. This study aimed to assess adherence and persistence to NOACs in patients with AF in two tertiary-care referral centers: Hospital Kuala Lumpur (HKL) and Hospital Serdang (HSDG). Materials and Methods: This was a retrospective cohort study that included all patients with AF who were treated with NOACs (dabigatran or rivaroxaban) in HKL and HSDG. Data were obtained from medical records and pharmacy databases. Adherence was assessed using proportion of days covered (PDC) over a 1-year duration. High adherence was defined as PDC ≥80%. A gap of >60 days between two consecutive refills was used to define non-persistence. Result: There were 281 patients who met the inclusion criteria, with 54.1% ( n = 152) male. There were 75.1% ( n = 211) patients on dabigatran and others on rivaroxaban. Only 66.9% ( n = 188) of patients achieved high adherence with PDC ≥80% and 69.8% ( n = 196) were persistence with >60-day gap over 12 months. Adherence and persistence were both influenced by treatment center, whereas polypharmacy only influenced adherence. Conclusion: Overall adherence and persistence to NOACs were suboptimal and varied between treatment centers, potentially due to institution-specific administrative and clinical practice differences. Clinical care and outcomes can potentially be optimized by identifying factors affecting adherence and persistence and by implementing interventions to improving them.

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Section: Discussionmentioning

confidence: 99%

Assessing adherence and persistence to non-vitamin K antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation in tertiary-care referral centers in Malaysia

et al. 2020

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“…Owing to its cheaper cost, warfarin is by far the most popular oral anticoagulant for treatment of various types of thromboembolism disorders even when compared to other novel oral anticoagulants that has been demonstrated to be noninferior and have less adverse effects than warfarin (Lippi et al, 2017, Lippi and Favaloro, 2015, Looi et al, 2017). However, due to its narrow therapeutic window and significant intra-and inter-individual dosing variabilities, the administration of warfarin requires extensive knowledge of the drug's pharmacokinetics and pharmacodynamics (Winkler, 2019).…”

Section: Introductionmentioning

confidence: 99%

Validation of HPLC and Liquid-Liquid Extraction Methods for Warfarin Detection in Human Plasma and its Application to a Pharmacokinetics Study

Chua

Abdullah

Yusof

et al. 2019

ASMScJ

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A reversed-phase HPLC method to determine total plasma warfarin was developed and validated. Warfarin was extracted from human plasma using a two-step liquid-liquid extraction method. The residue was reconstituted with a phenylbutazone standard solution, which was used as the internal standard. The analytical column was a Purospher STAR RP-18e (4 x 4mm I.D., 5m particle size). The mobile phase consisted of acetonitrile: potassium dihydrogen orthophosphate buffer solution at pH 6.5 [30:70 (v/v)] with a flow rate of 1mL/min. Both warfarin and phenylbutazone were detected using a photodiode array detector. The lower limit of quantification was 100ng/mL, while the limit of detection was 20ng/mL. The linearity of the assay was good (r2=0.992) in the concentration range from 0.1 - 6.0µg/mL. The extraction recovery of warfarin was 93.53 ± 12.40%. Both the intraday and interday quality control assay for warfarin demonstrated good precision and accuracy, with all of the percentage coefficients of variation being less than 15%. Warfarin was stable in human plasma for up to three months of storage. The validated method was successfully applied to four human samples for a pharmacokinetics study.

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Comparative Treatment Cost, Effectiveness and Safety of Dabigatran, Rivaroxaban and Warfarin in Atrial Fibrillation (AF) Patients: A Descriptive Study from Penang General Hospital (PGH)

Cited by 2 publications

References 0 publications

Assessing adherence and persistence to non-vitamin K antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation in tertiary-care referral centers in Malaysia

Assessing adherence and persistence to non-vitamin K antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation in tertiary-care referral centers in Malaysia

Validation of HPLC and Liquid-Liquid Extraction Methods for Warfarin Detection in Human Plasma and its Application to a Pharmacokinetics Study

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