2016
DOI: 10.1136/bmjopen-2016-011471
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Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care

Abstract: ObjectivesTo examine the characteristics and persistence in patients newly initiated with oral anticoagulants (OACs) for stroke prevention in non-valvular atrial fibrillation (NVAF).DesignCohort study in Clinical Practice Research Datalink.SettingUK primary care.Participants15 242 patients with NVAF newly prescribed apixaban, rivaroxaban, dabigatran or vitamin K antagonists (VKAs) between 1 December 2012 and 31 October 2014. 13 089 patients were OAC naïve.Outcome measuresPatient characteristics and risk of non… Show more

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Cited by 59 publications
(68 citation statements)
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References 31 publications
(43 reference statements)
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“…The low proportion of patients in whom OACs were initiated by cardiologists or other specialists (only 3.6% not based on general practitioners prescriptions), the selection of patients with incident AF, and their definition of VKA exposure could partly explain the apparent discordance between the current results and those of Martinez and colleagues . However, better adjusted 1‐year treatment persistence was also reported in nv‐AF patients initiating VKA versus dabigatran and versus rivaroxaban (77.8% vs 66.7% and vs 73.1%, respectively) in studies based on a UK primary care database accounting for the competing risk of death (N=13,089) and a Swedish claims database using a time‐partitioned approach (N=17,741, odds ratio estimates of 1‐year persistence with warfarin vs dabigatran: 1.81 [1.57–2.10] and vs rivaroxaban: 1.50 [1.24–1.81]) . The persistence rate of warfarin new users was also higher than that of patients initiating DOAC at 12 months (82% vs 70%, respectively) in a cohort study based on clinical data from Japanese nv‐AF patients …”
Section: Discussioncontrasting
confidence: 67%
See 1 more Smart Citation
“…The low proportion of patients in whom OACs were initiated by cardiologists or other specialists (only 3.6% not based on general practitioners prescriptions), the selection of patients with incident AF, and their definition of VKA exposure could partly explain the apparent discordance between the current results and those of Martinez and colleagues . However, better adjusted 1‐year treatment persistence was also reported in nv‐AF patients initiating VKA versus dabigatran and versus rivaroxaban (77.8% vs 66.7% and vs 73.1%, respectively) in studies based on a UK primary care database accounting for the competing risk of death (N=13,089) and a Swedish claims database using a time‐partitioned approach (N=17,741, odds ratio estimates of 1‐year persistence with warfarin vs dabigatran: 1.81 [1.57–2.10] and vs rivaroxaban: 1.50 [1.24–1.81]) . The persistence rate of warfarin new users was also higher than that of patients initiating DOAC at 12 months (82% vs 70%, respectively) in a cohort study based on clinical data from Japanese nv‐AF patients …”
Section: Discussioncontrasting
confidence: 67%
“…11,12 For these reasons, nonpersistence with DOAC therapy is a reason for concern in the clinical setting. [13][14][15] However, the overall results of claims-based observational studies comparing VKA and DOAC persistence rates have suggested better persistence with DOAC [16][17][18][19][20][21][22][23][24] ; most of these studies were sponsored by pharmaceutical companies. 25 Measuring treatment persistence using claims data can raise a number of methodological issues, 26 especially with VKA therapy due to its variable dosage or when interpreting non-persistence rates when switches between OAC classes are not adequately taken into account.…”
mentioning
confidence: 99%
“…Moreover, reasons for switching from VKAs to NOACs remain largely elusive . In addition, although several studies comparing treatment persistence among NOAC and VKA users have detected higher rates in the former group, the majority of them had a limited follow‐up …”
Section: Introductionmentioning
confidence: 99%
“…12,13 In addition, although several studies comparing treatment persistence among NOAC and VKA users have detected higher rates in the former group, the majority of them had a limited follow-up. 5,14 Thus, the objective of this study was to evaluate treatment initiation, switching, and persistence in patients with NVAF under oral anticoagulation based on a population-based cohort with long-term follow-up.…”
mentioning
confidence: 99%
“…Keywords: direct oral anticoagulants, DOACs, anticoagulation, warfarin, vitamin K antagonists. For many years, the only oral anticoagulants (OACs) available world-wide were the vitamin K antagonists (VKAs) (Johnson et al, 2016), of which warfarin is the most commonly prescribed in the United Kingdom (Protty & Hayes, 2017). The direct oral anticoagulants (DOACs) offer an attractive alternative to VKAs and have a number of advantages, including: (i) no requirement for routine monitoring, (ii) fixed dosing, (iii) more predictable dose responses, (iv) no food interactions, and (v) fewer drug interactions (Baglin, 2013).…”
Section: Discussionmentioning
confidence: 99%