Author:
Ruigómez Ana,Vora Pareen,Balabanova Yanina,Brobert Gunnar,Roberts Luke,Fatoba Samuel,Fernandez Oscar,García Rodríguez Luis Alberto
Abstract
ObjectiveTo determine discontinuation rates, patterns of use and predictors of discontinuation of non-vitamin K antagonist oral anticoagulants (NOACs) among patients with non-valvular atrial fibrillation (NVAF) in the first year of therapy.DesignPopulation-based cohort study.SettingUK primary care.Population11 481 patients with NVAF and a first prescription (index date) for apixaban, dabigatran or rivaroxaban (January 2012 to December 2016) with at least 1 year of follow-up and at least one further NOAC prescription in the year following the index date were identified. 1 year rates and patterns of discontinuation were described.Primary and secondary outcome measuresOutcome measures were the percentage of patients who, in the first year from starting NOAC therapy, discontinued with their oral anticoagulant (OAC) therapy (discontinuation was defined as a gap in OAC therapy of >30 days); switched OAC within 30 days; discontinued and reinitiated OAC therapy. Predictors of discontinuation were also evaluated.Results1 year discontinuation rates according to the index NOAC were 26.1% for apixaban, 40.0% for dabigatran and 29.6% for rivaroxaban. Reinitiation rates were 18.1% for apixaban, 21.7% for dabigatran and 17.3% for rivaroxaban, and switching rates were 2.8% for apixaban, 8.8% for dabigatran and 4.9% for rivaroxaban. More than 93% of reinitiations were with the index NOAC. Patients starting on dabigatran were more likely to switch OAC therapy than those starting on apixaban; ORs 4.28 (95% CI 3.24 to 5.65) for dabigatran and 1.89 (95% CI 1.49 to 2.39) for rivaroxaban. Severely reduced renal function was a predictor of any discontinuation, OR 1.77 (95% CI 1.28 to 2.44).ConclusionWhile the majority of patients with NVAF in the UK initiating NOAC treatment received continuous therapy in the first year of treatment, a substantial proportion of patients experienced gaps in treatment leaving them less protected against thromboembolism during these periods.
Reference41 articles.
1. The future of atrial fibrillation management: integrated care and stratified therapy;Kirchhof;The Lancet,2017
2. Esc guidelines for the management of atrial fibrillation developed in collaboration with EACTS;Kirchhof;Eur Heart J,2016
3. Nice implementation collaborative. consensus: supporting local implementation of NICE guidance on use of the novel (non-vitamin K antagonist) oral anticoagulants in non-valvular atrial fibrillation.
4. National Institute for Health and Care Excellence . Atrial fibrillation: management. clinical guideline. Available: nice.org.uk/guidance/cg180 [Accessed 18 Jun 2014].
5. Trends in the prescription of novel oral anticoagulants in UK primary care;Loo;Br J Clin Pharmacol,2017
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