Switching to Another Oral Anticoagulant and Drug Discontinuation Among Elderly Patients With Nonvalvular Atrial Fibrillation Treated With Different Direct Oral Anticoagulants

Abstract

We compared the risks of switching to another oral anticoagulant (OAC) and discontinuation of direct oral anticoagulants (DOACs) among elderly patients with nonvalvular atrial fibrillation (NVAF) who were prescribed rivaroxaban or dabigatran versus apixaban. Patients (≥65 years of age) with NVAF prescribed DOACs (January 1, 2013 to September 30, 2017) were identified from the Humana research database and grouped into DOAC cohorts. Cox regression analyses were used to evaluate whether the risk for switching to another OAC or discontinuing index DOACs differed among cohorts. Of the study population (N = 38 250), 55.9% were prescribed apixaban (mean age: 78.6 years; 49.8% female), 37.3% rivaroxaban (mean age: 77.4 years; 46.7% female), and 6.8% dabigatran (mean age: 77.0 years; 44.0% female). Compared to patients prescribed apixaban, patients prescribed rivaroxaban (hazard ratio [HR]: 2.08; 95% confidence interval [CI], 1.92-2.25; P < .001) or dabigatran (HR: 3.74; 95% CI, 3.35-4.18, P < .001) had a significantly higher risk of switching to another OAC during the follow-up; compared to patients prescribed apixaban, the risks of discontinuation were also higher for patients treated with rivaroxaban (HR: 1.10; 95% CI, 1.07-1.13, P < .001) or dabigatran (HR: 1.29; 95% CI, 1.23-1.35, P < .001).

Switching of oral anticoagulants in patients with nonvalvular atrial fibrillation: A narrative review

“…A total of 39 studies met the inclusion criteria. Of these, 36 reported the rate of OAC switching, 27,32–66 13 of which also conducted predictor analysis for switching 32,34–36,42,44,48,53,55,57,62,63,65 . Five studies assessed clinical outcomes of switching, 27,37,67–69 while three investigated reasons for switching 46,47,66 .…”

“…The majority of the studies were conducted in the United States (n = 10), 27,34,35,38,45,46,53,59,62,69 Nordic countries (n = 8; five, two and one from Denmark, Sweden and Norway, respectively) 33,44,47,48,50–52,63 and the UK (n = 5), 43,54,60,61,66 whereas three studies were multinational 32,37,56 . Claim databases and medical records were the principal type of data sources in most studies (n = 19) 27,33–36,38,40,42,45,51,53,57–59,64,66–69 . Primary care data, with or without linking to other data sources, were used in five studies; of these, four were conducted in the UK 43,54,60,61 and one in France 39 .…”

“…Fifteen studies reported the switching rate of DOACs as a class, with or without individual drug‐level switching 32,36,41,42,47,48,51–55,61,64–66 . Of the studies that assessed the switching rate, 14 studies were exclusively conducted among DOAC users, 33–35,38,41,47,48,51,53,55,59,61,64,66 five studies were in VKA users 44,46,49,57,62 and 13 studies were among users of both DOACs and VKAs 32,36,39,42,43,45,50,52,54,58,60,63,65 . The remaining four studies were focused on a single DOAC (two for dabigatran, 37,56 and one each for rivaroxaban 40 and apixaban 27 ).…”

“…The proportion of female patients ranged from 26.2% to 61.8% 34,38 . The mean CHA 2 DS 2 ‐VASc and HAS‐BLED scores were between 2.1 to 4.8 27,35 and 1.2 to 3.4, 27,37 respectively. Hypertension was the most common comorbidity reported by the studies (43.5‐97.3%) 45,52 .…”

Acute Kidney Failure due to Psoas Muscle Hemorrhage due to Apixban Use: A Case Report

“…Faktör Xa inhibisyonu doz bağımlı olup, trombin aktivitesini inhibe etmez. Heparin, düşük molekül ağırlıklı heparin ve Fondaparinux gibi indirekt trombin ve faktör Xa inhibitörlerinin aksine etki etmesi için antitrombinIII'e ihtiyaç duymaz (1,2). Apiksaban'ın CYP3A4'ü inhibe etme veya uyarma etkisi çok azdır.…”