Long-Term Persistence of Newly Initiated Warfarin Therapy in Chinese Patients With Nonvalvular Atrial Fibrillation

Wang, Zhizun; Du, Xin; Wang, Wei; Tang, Ri‐Bo; Luo, Jia; Li, Chao; Chang, Shuangyu; Liu, Xiaohui; Sang, Caihua; Yu, Rong‐Hui; Long, Deyong; Wu, Jiahui; Bai, Rong; Liu, Nian; Ruan, Yanfei; Ma, Changsheng

doi:10.1161/circoutcomes.115.002337

Cited by 36 publications

(40 citation statements)

References 40 publications

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“…Patients with paroxysmal AF were more likely to discontinue anticoagulants than those with persistent or permanent AF, which was consistent with another study (Wang et al, ). As patterns of AF were reported to be a strong predictor of stroke risk, compared with patients with paroxysmal AF, those with persistent or permanent AF suffered longer symptoms and higher risk of ischaemic stroke (Vanassche et al, ), which may translate to better persistence.…”

Section: Discussionsupporting

confidence: 90%

Persistence and outcomes of non‐vitamin K antagonist oral anticoagulants versus warfarin in patients with non‐valvular atrial fibrillation

Xie

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To compare persistence and outcomes of non‐vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in Chinese patients with non‐valvular atrial fibrillation (AF). Background Given the unpredictable warfarin response and the costliness of NOACs, more research is needed to clarify which drug enjoys better persistence and outcomes, helping to provide personalised care for patients. Design A prospective cohort study. Methods Chinese patients taking NOACs or warfarin from March 2016–April 2018 were followed up by telephone or outpatient visit at 3, 6 months and half a year thereafter. Anticoagulant persistence and outcomes including stroke and bleeding were collected. We used Cox regression to analyse data. This study was reported according to the STROBE guideline. Results A total of 344 patients were enrolled; 146 patients received NOACs including dabigatran and rivaroxaban, and 198 patients received warfarin. Persistence with anticoagulants was low and dropped sharply at the third month. Patients on NOACs had worse persistence at 3, 6 and 12 months than those on warfarin. There was no difference in the incidence of ischaemic stroke and bleeding between groups, although ischaemic stroke and major bleeding occurred less frequently in the NOACs group. Paroxysmal AF, no heart failure and no stroke were predictors of NOACs non‐persistence. Prior catheter ablation and no diabetes were associated with poor persistence of warfarin. The main reason for anticoagulant cessation was patient preference. Conclusions Chinese patients taking NOACs had lower persistence, similar rate of ischaemic stroke and bleeding compared with those on warfarin. Further inventions are needed to improve persistence in Chinese patients on NOACs. Relevance to clinical practice Anticoagulation should highlight both persistence and outcomes emphasising personalised care of different drugs. Further interventions to improve persistence should be developed based on causes and risk factors and carried out in the third month of therapy.

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Section: Discussionsupporting

confidence: 90%

Persistence and outcomes of non‐vitamin K antagonist oral anticoagulants versus warfarin in patients with non‐valvular atrial fibrillation

Xie

et al. 2019

Journal of Clinical Nursing

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“…Patients with permanent AF were more likely to receive anticoagulant therapy in this study, which is in line with the study in 2016 by Wang et al [32]. In 2012, Chiang et al reported that stroke rates were higher in patients with persistent than paroxysmal AF, while these were highest in patients with permanent AF [33].…”

Section: Duration and Type Of Afsupporting

confidence: 91%

Current status and factors influencing oral anticoagulant therapy among patients with non-valvular atrial fibrillation in Jiangsu province, China: a multi-center, cross-sectional study

Liu

Yang

et al. 2020

BMC Cardiovasc Disord

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Background: It has been reported that oral anticoagulation (OAC) is underused among Chinese patients with nonvalvular atrial fibrillation (NVAF). Non-vitamin K antagonist oral anticoagulants (NOAC) have been recommended by recent guidelines and have been covered since 2017 by the Chinese medical insurance; thus, the overall situation of anticoagulant therapy may change. The aim of this study was to explore the current status of anticoagulant therapy among Chinese patients with NVAF in Jiangsu province. Methods: This was a multi-center, cross-sectional study that was conducted in seven hospitals from January to September in 2017. The demographic characteristics and medical history of the patients were collected by questionnaire and from the medical records. Multivariate logistic regression was used to identify factors associated with anticoagulant therapy. Results: A total of 593 patients were included in the analysis. A total of 35.6% of the participants received OAC (11.1% NOAC and 24.5% warfarin). Of those patients with a high risk of stroke, 11.1% were on NOAC, 24.8% on warfarin, 30.6% on aspirin, and 33.6% were not on medication. Self-paying, duration of AF ≥5 years were negatively associated with anticoagulant therapy in all patients (OR 1.724, 95% CI 1.086~2.794; OR 1.471, 95% CI 1.006~2.149, respectively), whereas, permanent AF was positively associated with anticoagulant therapy (OR 0.424, 95% CI 0.215~0.839). Among patients with high risk of stroke, self-paying and increasing age were negatively associated with anticoagulant therapy (OR 2.305, 95% CI 1.186~4.478; OR 1.087, 95% CI 1.041~1.135, respectively). Conclusions: Anticoagulant therapy is positively associated with permanent AF and negatively associated with selfpaying, duration of AF > 5 years. Furthermore, the current status of anticoagulant therapy among Chinese patients with NVAF in Jiangsu province does not appear optimistic. Therefore, further studies should focus on how to improve the rate of OAC use among NVAF patients. In addition, policy makers should pay attention to the economic situation of the patients with NVAF using NOAC. Trial registration: 2,017,029. Registered 20 March 2017 (retrospectively registered).

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“…To prevent stroke and embolic events in AF patients with high thrombotic risk (CHA 2 DS 2 -VASc score ≥2 in male and ≥3 in female), oral anticoagulants (OACs) has been suggested to be effective, with class I, level A recommendation [5]. For Chinese population, however, insufficient anticoagulation was the major obstacle of AF management, resulted from the low compliance at a great extent [6]. Furthermore, labile international normalized ratio (INR) in patients taking warfarin and insufficient dosage of new OACs rendered anticoagulation far from enough.…”

Section: Introductionmentioning

confidence: 99%

Cryoablation Combined with Left Atrial Appendage Closure: A Safe and Effective Procedure for Paroxysmal Atrial Fibrillation Patients

Ren

Zhang

Zhu

et al. 2020

Cardiology Research and Practice

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Background. Catheter ablation combined with left atrial appendage closure (LAAC) was reported as a feasible strategy for atrial fibrillation (AF) patients with high risk of stroke or contraindications of oral anticoagulants. We aimed to observe the short-term safety and efficacy of combining cryoballoon ablation (CBA) with LAAC in paroxysmal (PAF) patients. Method and Results. From Jan 2016 to Dec 2017, 304 patients diagnosed with nonvalvular, drug-refractory PAF were included, who underwent either CBA alone (n = 262) or combined procedure (n = 42). Instant pulmonary vein isolation (PVI) with CBA was achieved in all patients, while successful LAAC achieved in 41 (97.6%) of combined procedure patients. 1-year freedom of AF rate was lower in combined procedure group (84.7% vs 70.7%, p=0.04), with unadjusted hazard ratio (HR = 1.97) and 95% confidence interval (CI) 1.03–3.77. However, the multivariate COX model revealed left atrial diameter (p=0.002, HR = 1.10, and 95% CI 1.04, 1.17), rather than procedure type (p=0.51, HR = 1.34, and 95% CI 0.57, 3.17), was the predictor for freedom of AF. Only 2 patients in the CBA group had stroke, contributing to the nonsignificant higher stroke incidence (p=1.00). Transoesophageal echochardiography (TEE) achieved in 35 patients (83.3%) showed complete occlusion with no obvious residual flow (>3 mm), Device-related thrombosis, or pericardial perfusion. All-cause mortality, rehospitalization, and complication rates were similar. Conclusion. Combining CBA with LAAC in a single procedure is a feasible strategy for PAF patients, with comparable short-term safety and efficacy to CBA alone.

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Long-Term Persistence of Newly Initiated Warfarin Therapy in Chinese Patients With Nonvalvular Atrial Fibrillation

Cited by 36 publications

References 40 publications

Persistence and outcomes of non‐vitamin K antagonist oral anticoagulants versus warfarin in patients with non‐valvular atrial fibrillation

Persistence and outcomes of non‐vitamin K antagonist oral anticoagulants versus warfarin in patients with non‐valvular atrial fibrillation

Current status and factors influencing oral anticoagulant therapy among patients with non-valvular atrial fibrillation in Jiangsu province, China: a multi-center, cross-sectional study

Cryoablation Combined with Left Atrial Appendage Closure: A Safe and Effective Procedure for Paroxysmal Atrial Fibrillation Patients

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