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Medium to long-term persistence with non-vitamin K oral anticoagulants in patients with atrial fibrillation: Australian experience.
Curr Med Res Opin. 2017 Apr 20;:1-10
Authors: Simons LA, Ortiz M, Freedman SB, Waterhouse BJ, Colquhoun D
Abstract
OBJECTIVE: Long-term anticoagulant therapy with non-valvular atrial fibrillation (AF) is essential to prevent thromboembolic complications, especially ischemic stroke. This study examines medium-term persistence in AF patients using a non-vitamin K antagonist oral anticoagulant drug (NOAC).
RESEARCH DESIGN AND METHODS: We assessed national Pharmaceutical Benefit Scheme records December 2013 through September 2016 for initial prescription of a NOAC in a 10% random sample of concessional patients. Key outcome measures were: (a) proportions filling first repeat prescription, (b) proportions persisting with NOAC over 12 and 30 months and (c) proportions switching to another NOAC or warfarin.
RESULTS: A total of 8,656 patients with AF initiated a NOAC (3352 apixaban, 1340 dabigatran, 3964 rivaroxaban). Mean age was 77 years, 53% male. 91% collected the first repeat prescription for any NOAC, 70% and 57% collected any NOAC or subsequent warfarin prescription over 12 months and 30 months respectively; 8.9% had switched to warfarin. The proportions switching from apixaban, dabigatran and rivaroxaban to a different NOAC were 14%, 31% and 17% respectively. In a regression model adjusting for age, gender and comorbidity, apixaban-initiated patients over 30 months were 28% more likely to persist with any anticoagulant therapy compared with dabigatran-initiated [hazard ratio (95% CI) 1.28(1.16-1.42)] and 15% more likely to persist compared with rivaroxaban-initiated [1.15(1.06-1.24)]. Rivaroxaban-initiated were 12% more likely to persist compared with dabigatran-initiated [1.12(1.02-1.24)].
CONCLUSIONS: Long-term persistence with anticoagulation in patients with AF remains a concern, even with NOACs. Patients initiated to apixaban appear to experience better medium-term persistence compared with rivaroxaban or dabigatran.
PMID: 28425296 [PubMed - as supplied by publisher]