| アブストラクト | OBJECTIVE: To 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. DESIGN: Population-based cohort study. SETTING: UK primary care. POPULATION: 11 481 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 MEASURES: Outcome 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. RESULTS: 1 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). CONCLUSION: While 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. |
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| ジャーナル名 | BMJ open |
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| 投稿日 | 2019/10/21 |
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| 投稿者 | Ruigomez, Ana; Vora, Pareen; Balabanova, Yanina; Brobert, Gunnar; Roberts, Luke; Fatoba, Samuel; Fernandez, Oscar; Garcia Rodriguez, Luis Alberto |
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| 組織名 | Pharmacoepidemiology, Spanish Centre for Pharmacoepidemiological Research,;Madrid, Spain aruigomez@ceife.es.;Epidemiology, Bayer AG, Berlin, Germany.;Epidemiology, Bayer AB, Stockholm, Sweden.;Study Medical Experts, Bayer plc, Reading, UK.;Medical Affairs, Bayer plc, Reading, UK.;Madrid, Spain. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/31630107/ |
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