Evaluating utilization patterns of oral anticoagulants in routine care.
J Thromb Haemost. 2019 Apr 30;:
Authors: Gopalakrishnan C, Schneeweiss E, Bartels DB, Zint K, Santiago Ortiz A, Huybrechts KF
BACKGROUND: Direct oral anticoagulants (DOACs) were developed as an alternative to vitamin K antagonists for a variety of indications. Unlike warfarin, DOACs do not require regular plasma level monitoring.
OBJECTIVE: We investigated whether this simplification in management impacts persistence on DOACs versus warfarin.
METHODS: Within two US commercial health insurance databases (MarketScan and ClinformaticsTM DataMart), we compared baseline characteristics and evaluated rates of non-persistence (>=30-day treatment gap or switching) among patients with non-valvular atrial fibrillation who initiated an oral anticoagulant between October 2010 and September 2015 RESULTS: In the larger of the two data sources (MarketScan), we identified 166,690 anticoagulant initiators during the study period. After propensity score (PS) matching, 24,141 dabigatran initiators, 26,066 rivaroxaban and 12,578 apixaban initiators were included along with the 1:1 matched warfarin initiators. The proportion of patients who were non-persistent after 12 months was lower for DOAC users (dabigatran 66%, rivaroxaban 60%, apixaban 53%) compared to warfarin users (72%). The same relative ranking was observed in direct comparisons among the DOACs after PS-matching. Findings in ClinformaticsTM DataMart were similar.
CONCLUSION: Results from this long-term surveillance program showed that patients who initiated DOACs were more likely to be persistent to therapy compared to those who initiated warfarin. Persistence to anticoagulant therapy was generally poor in commercially insured patients. This article is protected by copyright. All rights reserved.
PMID: 31038824 [PubMed - as supplied by publisher]