Safety of once- or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study

Abstract

Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once- or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1:1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 ± 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.

Comparison of the Treatment Persistence Among 4 Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation: A 5‐Year Retrospective Cohort Study

“…However, it was pointed out that a once‐daily regimen had greater peak‐to‐trough blood levels, which may increase the risk of bleeding 21 . The NOAC‐TR study, 22 which examined adherence to a once‐ or twice‐daily regimen of DOACs, showed that a once‐daily regimen contributed to better adherence, although there was no difference in the incidence rate of bleeding. In addition, when switching and discontinuation rates were examined separately in the present study, only switching rates differed among DOACs.…”

Non–Vitamin K Antagonist Oral Anticoagulants and Factors Influencing the Ischemic and Bleeding Risk in Elderly Patients With Atrial Fibrillation: A Review of Current Evidence

“…The authors suggested that other risk factors may independently affect nonadherence, and the combined action of these factors is necessary for the development of bleeding complications. 89 …”

Analysis of Influencing Factors of Compliance with Non-Vitamin K Antagonist Oral Anticoagulant in Patients with Nonvalvular Atrial Fibrillation and Correlation with the Severity of Ischemic Stroke

“…In our study, the incidence of ischemic stroke in the good compliance group was lower than that in the poor compliance group, and the stroke degree of the 3 patients in the good compliance group was lower than that of the 12 patients in the poor compliance group. Moreover, Pearson correlation analysis showed that the compliance of NOACs in NVAF patients was negatively correlated with the severity of ischemic stroke [ 17 ]. These indicate that active and effective treatment with NOACs is an independent protective factor for effectively reducing the severity of ischemic stroke [ 18 ].…”