A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF)

Abstract

Background/Aims: Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are more convenient to administer than warfarin, their lack of monitoring may predispose patients to nonpersistence. We compared the persistence of NOAC and VKA treatment for AF in real-world practice. Methods: In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 7,013 patients with nonvalvular AF (mean age 67.2 ± 10.9 years, women 36.4%) were consecutively enrolled between June 2016 and June 2017 from 10 tertiary hospitals in Korea. This study included 3,381 patients who started OAC 30 days before enrollment (maintenance group) and 572 patients who newly started OAC (new-starter group). The persistence rate of OAC was evaluated. Results: In the maintenance group, persistence to OAC declined during 6 months, to 88.3% for VKA and 95.5% for NOAC (p < 0.0001). However, the persistence rate was not different among NOACs. In the new-starter group, persistence to OAC declined during 6 months, to 78.9% for VKA and 92.1% for NOAC (p < 0.0001). The persistence rate was lower for rivaroxaban (83.7%) than apixaban (94.6%) and edoxaban (94.1%, p < 0.001). In the new-starter group, diabetes, valve disease, and cancer were related to nonpersistence of OAC. Conclusions: Nonpersistence was significantly lower with NOAC than VKA in both the maintenance and new-starter groups. In only the new-starter group, apixaban or edoxaban showed higher persistence rates than rivaroxaban.

The difference of burden of ectopic beats in different types of atrial fibrillation and the effect of atrial fibrillation type on stroke risk in a prospective cohort of patients with atrial fibrillation (CODE-AF registry)

“…Our previous study showed that OAC was used in 82.7% of patients, and NOAC in more than two-third of OAC prescribed patients in this registry 17 . Moreover, persistence to OAC declined for 6 months only to 95.5% for NOAC 37 . Therefore, high OAC rate with high NOAC usage, and high persistent rate might be related with low stroke rate in this study.…”

Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy

“…Nevertheless, the therapeutic range for all VKA drugs is usually unsatisfactory; as a consequence, thromboembolic and hemorrhagic events are more frequent in patients treated with VKAs than DOACs [ 112 , 114 , 115 , 116 , 117 ]. Lastly, although treatment adherence was comparable between DOACs and VKAs, treatment satisfaction and persistence are significantly lower with VKAs than DOACs; CKD and history of bleeding represent some of the main factors associated with absence and/or non-adherence to anticoagulant therapy in everyday practice [ 97 , 118 , 119 , 120 ].…”

Edoxaban for stroke prevention in atrial fibrillation in routine clinical care: 1-year follow-up of the prospective observational ETNA-AF-Europe study

“…3 Non-vitamin K oral anticoagulant use in clinical practice is increasingly becoming the standard of care. Several registries [4][5][6] and retrospective analyses 7,8 have assessed outcomes of three (apixaban, dabigatran, and rivaroxaban) of the four available NOACs, but routine clinical data on edoxaban, the fourth NOAC that entered the clinical arena, are scarce. Regulators such as the European Medicines Agency have regularly requested for data on the safety of recently approved therapies in routine clinical care as part of the postapproval safety plan of these recently approved medications.…”