| アブストラクト | AIMS: We characterized the utilization and long-term treatment persistence of direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (NVAF) and liver disease. METHOD: Using the UK Clinical Practice Research Datalink, we assembled a population-based cohort of NVAF patients with liver disease initiating oral anticoagulants between 2011 and 2020. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) of the association between patient characteristics and initiation of DOACs vs vitamin K antagonists (VKAs). Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs of the association between patient characteristics and the switch from VKAs to DOACs vs remaining on VKAs. We also assessed the 5-year treatment persistence with DOACs vs VKAs, and whether ischemic stroke or bleeding preceded treatment discontinuation. RESULTS: Our cohort included 3167 NVAF patients with liver disease initiating DOACs (n = 2247, 71%) or VKAs (n = 920, 29%). Initiators of DOACs were more likely to have prior ischemic stroke (OR 1.44, 95% CI 1.12-1.85) than VKA initiators but less likely to have used antiplatelet agents (OR 0.66, 95% CI 0.53-0.82). Patients switching to DOACs were more likely to have used selective serotonin reuptake inhibitors (HR 1.64, 95% CI 1.13-2.37) than those remaining on VKAs. At 5 years, 31% of DOAC initiators and 9% of VKA initiators remained persistent. Only few patients were diagnosed with ischemic stroke or bleeding prior to treatment discontinuation. CONCLUSION: Most NVAF patients with liver disease initiated treatment with DOACs. Long-term persistence with DOACs was higher than with VKAs but remained relatively low. |
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| 組織名 | Department of Epidemiology, Biostatistics and Occupational Health, McGill;University, Montreal, Quebec, Canada.;Department of Medicine, McGill University, Montreal, Quebec, Canada.;Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada.;Institute of Clinical Pharmacology and Toxicology, Charite-Universitatsmedizin;Berlin, Berlin, Germany.;Department of Pediatrics, McGill University, Montreal, Quebec, Canada.;Division of Gastroenterology and Hepatology, McGill University Health Centre,;Montreal, Quebec, Canada.;Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec,;Canada. |
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