Higher Persistence in Newly Diagnosed Nonvalvular Atrial Fibrillation Patients Treated With Dabigatran Versus Warfarin

Abstract

Background-Oral anticoagulation therapy is the primary tool in reducing stroke risk in patients with nonvalvular atrial fibrillation but is underused. Patients nonpersistent with therapy contribute to this underuse. The objective of this study was to compare persistence rates in newly diagnosed nonvalvular atrial fibrillation patients treated with warfarin versus dabigatran as their oral anticoagulation. Methods and Results-US Department of Defense administrative claims were used to identify patients receiving warfarin or dabigatran between October 28, 2010, and June 30, 2012. Patient records were examined for a minimum of 12 months before index date to restrict the analyses to those newly diagnosed with nonvalvular atrial fibrillation and naive-to-treatment, identifying 1775 on warfarin and 3370 on dabigatran. Propensity score matching was used to identify 1745 matched pairs. Persistence was defined as time on therapy to discontinuation. Kaplan-Meier curves were used to depict persistence over time. Cox proportional hazards model was used to determine the factors significantly associated with persistence. Using a 60-day permissible medication gap, the persistence rates were higher for dabigatran than for warfarin at both 6 months (72% versus 53%) and 1 year (63% versus 39%

Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation

“…Rather, we see that adherence to anticoagulation continues to be a challenge, regardless of the medication used. Our findings of low adherence rates were consistent with previous studies reporting poor adherence to dabigatran 3, 31, 32. Oral anticoagulants are purely preventive and address no symptoms, so they are especially vulnerable to nonadherence.…”

“…Published claims‐based algorithms were used in defining outcomes and validated in previous studies 3, 14, 15, 16, 17. ICD‐9‐CM codes are given in Table 1.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Mimo tych dowodów niedostateczne stosowanie lub przedwczesne przerywanie OAC wciąż jest częste. Do najczęstszych przyczyn wstrzymywania się z OAC lub przerywania go należą incydenty krwotoczne -zarówno poważne, jak i jedynie kłopotliwe -postrzegane "duże ryzyko krwawienia" podczas stosowania OAC, a także wysiłki, które trzeba włożyć w monitorowanie i modyfikowanie leczenia za pomocą VKA [352,[355][356][357][358][359]. Znaczne ryzyko udaru mózgu bez OAC jest jednak często większe niż ryzyko krwawienia podczas stosowania OAC, nawet u osób w podeszłym wieku, pacjentów z dysfunkcją poznawczą oraz pacjentów często upadających lub z zespołem kruchości [360,361].…”

Reversing targeted oral anticoagulants

“…In addition to better outcomes, patients on dabigatran (RE-LY trial) were more likely to stay on their anticoagulant regimen than patients taking warfarin. 15 Of course, these benefits of NOACs were based on results of major clinical trials in which subjects were more highly selected than in the real world [after US Food and Drug Administration (FDA) approval]. However, at least in this patient population, outcomes appear to be better with NOACs than with warfarin, even without antidotes for the NOACs.…”