The safety and persistence of non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients treated in a well-structured atrial fibrillation clinic.
Curr Med Res Opin. 2016 Jan 14;:1-28
Authors: Al-Khalili F, Lindström C, Benson L
AIMS: To examine the long-term persistence and safety of the non-vitamin K antagonist oral anticoagulants (NOAC); dabigatran (D), rivaroxaban (R) and apixaban (A) in patients with non-valvular atrial fibrillation (AF) treated in the framework of a well-structured, nurse-based AF unit for initiation and follow-up of NOAC.
METHODS: Retrospective clinical data were collected for 766 consequent patients from a single cardiology outpatient clinic incorporating the AF unit.
RESULTS: The follow-up time was 367 days (183-493) for D patients, 432 days (255-546) for R patients and 348 days (267-419) for A patients. No significant differences were found between the three groups in regards to age, sex, renal function, or CHA2DS2-VASc score. For all bleeding events the incidence rates per 100 patient-years of follow-up (95% Confidence Interval (CI), p-value) were reported more often for treatment with R (17.2, 12.7-22.8) than for D (7.0, 4.0 - 11.3, p=0.001), and A (8.7, 5.2-13.6, p=0.013). The differences remained significant after adjustment for clinically relevant variables. Discontinuation rates (n=167) were lower for A (11.5, 7.5-16.8) than D (30, 23.4-37.9, p <0.001) and than for R (23.9, 18.6-30.1, p= 0.001), that were mainly attributed to drug-specific side effects and bleedings. The majority of discontinued patients (n= 142, 85%) proceeded with other types of oral anticoagulants.
LIMITATION: The main limitation of the study is the small patient population with a short follow-up time.
CONCLUSION: In a retrospective study at a single AF clinic, NOAC showed significantly different bleeding rates and varied discontinuation rates when compared to each other, related mainly to agent- specific side effects and bleedings. The majority of patients that discontinued proceeded with other kinds of oral anticoagulant.
PMID: 26765366 [PubMed - as supplied by publisher]