Persistence With Dabigatran Therapy at 2 Years in Patients With Atrial Fibrillation

Paquette, Miney; França, Lionel Riou; Teutsch, Christine; Diener, Hans‐Christoph; Lu, Shihai; Dubner, Sérgio; Sheng, Chang; Rothman, Kenneth J.; Zint, Kristina; Halperin, Jonathan L.; Huisman, Menno V.; Lip, Gregory Y. H.; Nieuwlaat, Robby

doi:10.1016/j.jacc.2017.07.793

Cited by 42 publications

(55 citation statements)

References 22 publications

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“…These results are also comparable to the non‐persistence rate of rivaroxaban in patients with atrial fibrillation from the Dresden registry (19% at an average of 1.5 years of follow‐up), in which patients were frequently monitored by study design. A similar non‐persistent rate of 23% at 2 years of follow‐up for dabigatran was found in an observational study by Paquette et al, where AF patients on dabigatran were regularly monitored by study design (at 3, 6, 12 and 24 months). In short, all studies that found a low non‐persistence rate for oral anticoagulant use amongst patients with atrial fibrillation had presence of patient monitoring in common.…”

Section: Discussionsupporting

confidence: 81%

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Zielinski

Rein

Teichert

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: In contrast to vitamin K antagonists (VKA), direct oral anticoagulants (DOAC's) are not strictly monitored and dose titrated by anticoagulation clinics in the Netherlands. This may affect drug persistence of atrial fibrillation (AF) patients, whom often require lifelong treatment.Objectives: To assess persistence of DOACs and of VKAs in patients with AF.

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Section: Discussionsupporting

confidence: 81%

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Zielinski

Rein

Teichert

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…All DOACs have proven efficacy compared with VKA, although at much lower time in therapeutic range (TTR) in trials than usual clinical practice, but ‘head-to-head’ DOAC trial comparisons are unlikely. However, several studies have shown suboptimal adherence and persistence for DOACs in different countries and settings, even compared with VKA, and effective interventions are lacking 12–14. Underlying causes include factors at social, economic, health system, clinician and patient levels.…”

Section: Introductionmentioning

confidence: 99%

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Banerjee

Benedetto

Gichuru

et al. 2019

Heart

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background Despite simpler regimens than vitamin K antagonists (VKas) for stroke prevention in atrial fibrillation (aF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (ehrs). Objective We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence. Methods in UK primary care ehr (The health information network 2011-2016), we investigated adherence and persistence at 1 year for oral anticoagulants (Oacs) in adults with incident aF. Baseline characteristics were analysed by Oac and adherence/persistence status. risk factors for nonadherence and non-persistence were assessed using cox and logistic regression. Patterns of adherence and persistence were analysed. results among 36 652 individuals with incident aF, cardiovascular comorbidities (median cha 2 Ds 2 Vasc[congestive heart failure, hypertension, age≥75 years, Diabetes mellitus, stroke, Vascular disease, age 65-74 years, sex category] 3) and polypharmacy (median number of drugs 6) were common. adherence was 55.2% (95% ci 54.6 to 55.7), 51.2% (95% ci 50.6 to 51.8), 66.5% (95% ci 63.7 to 69.2), 63.1% (95% ci 61.8 to 64.4) and 64.7% (95% ci 63.2 to 66.1) for all Oacs, VKa, dabigatran, rivaroxaban and apixaban.One-year persistence was 65.9% (95% ci 65.4 to 66.5), 63.4% (95% ci 62.8 to 64.0), 61.4% (95% ci 58.3 to 64.2), 72.3% (95% ci 70.9 to 73.7) and 78.7% (95% ci 77.1 to 80.1) for all Oacs, VKa, dabigatran, rivaroxaban and apixaban. risk of non-adherence and non-persistence increased over time at individual and system levels. increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all Oacs. Overall rates of 'primary non-adherence' (stopping after first prescription), 'non-adherent nonpersistence' and 'persistent adherence' were 3.5%, 26.5% and 40.2%, differing across Oacs. Conclusions adherence and persistence to Oacs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across Oacs in individuals and populations.on July 10, 2020 by guest. Protected by copyright.

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“…Previous reports suggest a rapid decline in adherence to oral anticoagulation with vitamin K antagonists within the first years [ 11 , 12 ]. With the advent of the NOACs, higher adherence rates have been reported [ 13 , 14 , 15 ]. A retrospective analysis of primary care data in Germany reports about a persistence to apixaban after 1 year in 62.9% with apixaban and 57.5% with VKAs [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Use, Persistence, Efficacy, and Safety of Apixaban in Patients with Non-Valvular Atrial Fibrillation in Unselected Patients in Germany. Results of the Prospective Apixaban in Atrial Fibrillation (APAF) Registry

et al. 2020

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Introduction Apixaban has been shown to be superior to warfarin in patients with non-valvular atrial fibrillation in the randomized ARISTOTLE trial and its use is recommended in current guidelines. There are only scarce data about its use, efficacy, and safety in unselected patients in Germany. Methods and Results The APAF registry is a prospective non-interventional study enrolling 5015 patients with non-valvular atrial fibrillation. Of these, 1349 (26.9%) patients were initially treated with apixaban and followed up at 3 and 12 months. The dose of apixaban used was 1 × 2.5 mg in 1.6%, 2 × 2.5 mg in 30.4%, and 2 × 5 mg daily in 68.0% of patients, respectively. Inappropriate underdosing of apixaban was observed in 22.3%, mostly in elderly patients with higher HAS-BLED Score and a history of bleeding. Persistence to apixaban after 1 year was 88.6%, while the dose was changed in 3.7% of patients. Switching to other NOACs or VKAs occurred in 5.1%. After 12 months, all-cause mortality was 5.0%, non-fatal stroke occurred in 0.4%, non-fatal myocardial infarction in 0.6%, ISTH major bleeding in 0.8%, moderate or minor bleeding in 4.3% of patients, respectively. Conclusions In this prospective experience in unselected patients with atrial fibrillation, persistence to apixaban was high, and efficacy and safety were comparable to the results in clinical trials, supporting its use in clinical practice. Electronic supplementary material The online version of this article (10.1007/s40119-020-00188-1) contains supplementary material, which is available to authorized users.

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Persistence With Dabigatran Therapy at 2 Years in Patients With Atrial Fibrillation

Cited by 42 publications

References 22 publications

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Use, Persistence, Efficacy, and Safety of Apixaban in Patients with Non-Valvular Atrial Fibrillation in Unselected Patients in Germany. Results of the Prospective Apixaban in Atrial Fibrillation (APAF) Registry

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