Persistence of non‐vitamin K antagonist oral anticoagulant use in Japanese patients with atrial fibrillation: A single‐center observational study

Shiga, Tsuyoshi; Naganuma, Miyoko; Nagao, Takehiko; Maruyama, Kenji; Suzuki, Atsushi; Murasaki, Kagari; Hagiwara, Nobuhisa

doi:10.1016/j.joa.2015.04.004

Cited by 48 publications

(65 citation statements)

References 37 publications

(36 reference statements)

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“…Patients receiving NOACs had worse persistence than those prescribed warfarin in our study, which was consistent with Shiga's study in Japan (Shiga et al, ). In the RE‐LY trial, the rates of dabigatran discontinuation at 1 and 2 year were also reported to be higher than warfarin (Connolly et al, ).…”

Section: Discussionsupporting

confidence: 92%

Persistence and outcomes of non‐vitamin K antagonist oral anticoagulants versus warfarin in patients with non‐valvular atrial fibrillation

Xie

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To compare persistence and outcomes of non‐vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in Chinese patients with non‐valvular atrial fibrillation (AF). Background Given the unpredictable warfarin response and the costliness of NOACs, more research is needed to clarify which drug enjoys better persistence and outcomes, helping to provide personalised care for patients. Design A prospective cohort study. Methods Chinese patients taking NOACs or warfarin from March 2016–April 2018 were followed up by telephone or outpatient visit at 3, 6 months and half a year thereafter. Anticoagulant persistence and outcomes including stroke and bleeding were collected. We used Cox regression to analyse data. This study was reported according to the STROBE guideline. Results A total of 344 patients were enrolled; 146 patients received NOACs including dabigatran and rivaroxaban, and 198 patients received warfarin. Persistence with anticoagulants was low and dropped sharply at the third month. Patients on NOACs had worse persistence at 3, 6 and 12 months than those on warfarin. There was no difference in the incidence of ischaemic stroke and bleeding between groups, although ischaemic stroke and major bleeding occurred less frequently in the NOACs group. Paroxysmal AF, no heart failure and no stroke were predictors of NOACs non‐persistence. Prior catheter ablation and no diabetes were associated with poor persistence of warfarin. The main reason for anticoagulant cessation was patient preference. Conclusions Chinese patients taking NOACs had lower persistence, similar rate of ischaemic stroke and bleeding compared with those on warfarin. Further inventions are needed to improve persistence in Chinese patients on NOACs. Relevance to clinical practice Anticoagulation should highlight both persistence and outcomes emphasising personalised care of different drugs. Further interventions to improve persistence should be developed based on causes and risk factors and carried out in the third month of therapy.

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Section: Discussionsupporting

confidence: 92%

Persistence and outcomes of non‐vitamin K antagonist oral anticoagulants versus warfarin in patients with non‐valvular atrial fibrillation

Xie

et al. 2019

Journal of Clinical Nursing

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“…However, VKA adherence could not be reliably assessed due to dynamic dosing on claims data. While the literature reports mixed results on the comparative persistence of DOAC versus VKA, whether or not DOAC patients have better persistence rates than VKA patients in no way lessens the issue of poor adherence with DOACs, now recommended as first‐line treatment over VKA for stroke prevention . In contrast, for clinical practice, our results suggest that initiating DOAC as first‐line treatment might not necessarily result in good adherence in nv‐AF patients.…”

Section: Discussionmentioning

confidence: 99%

Adherence with direct oral anticoagulants in nonvalvular atrial fibrillation new users and associated factors: a French nationwide cohort study

Maura

Pariente

Alla

et al. 2017

Pharmacoepidemiology and Drug

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PurposeDirect oral anticoagulants (DOACs) have been promoted in patients with nonvalvular atrial fibrillation (nv‐AF) as a more convenient alternative to vitamin K antagonists. We estimated 1‐year dabigatran and rivaroxaban adherence rates in nv‐AF patients and assessed associations between baseline patient characteristics and nonadherence.MethodsThis cohort study included OAC‐naive nv‐AF patients with no contraindications to OAC, who initiated dabigatran and rivaroxaban, using nationwide data from French national health care databases. One‐year adherence was defined by the proportion of days covered of 80% or more over a fixed 1‐year period after treatment initiation. Associations between nonadherence and baseline patient characteristics were assessed using multivariate logistic regression models.ResultsThe population was composed of 11 141 dabigatran (women: 48%; mean age: 74 ± 10.7 y; ≥80 y: 34.9%) and 11 126 rivaroxaban (46.5%; 74 ± 10.9 y; 34.8%) new users. One‐year adherence was 53.3% in dabigatran‐treated and 59.9% in rivaroxaban‐treated patients, consistent with numerous subgroup analyses. A switch to vitamin K antagonist was observed in 14.5% of dabigatran and 11.7% of rivaroxaban patients; 10.2% and 5.9% of patients switched to another DOAC, respectively; and 4.3% of patients died in the 2 cohorts. In patients who did not die or switch during the follow‐up, 1‐year adherence was 69.6% in dabigatran‐treated and 72.3% in rivaroxaban‐treated patients. Having concomitant ischemic heart diseases was associated with an increased risk of nonadherence in the 2 cohorts.ConclusionIn this real‐life study, 1‐year adherence to DOAC is poor in nv‐AF new users. Despite the introduction of DOAC, adherence to OACs may remain a significant challenge in AF patients.

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“…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%

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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Persistence of non‐vitamin K antagonist oral anticoagulant use in Japanese patients with atrial fibrillation: A single‐center observational study

Cited by 48 publications

References 37 publications

Persistence and outcomes of non‐vitamin K antagonist oral anticoagulants versus warfarin in patients with non‐valvular atrial fibrillation

Persistence and outcomes of non‐vitamin K antagonist oral anticoagulants versus warfarin in patients with non‐valvular atrial fibrillation

Adherence with direct oral anticoagulants in nonvalvular atrial fibrillation new users and associated factors: a French nationwide cohort study

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

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