Tomas Forslund1,2, Björn Wettermark3,4, Paul Hjemdahl3. 1. Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology Unit, Karolinska Institutet/Karolinska University Hospital, Solna, 171 76, Sweden. tomas.forslund@sll.se. 2. Public Healthcare Services Committee, Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden. tomas.forslund@sll.se. 3. Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology Unit, Karolinska Institutet/Karolinska University Hospital, Solna, 171 76, Sweden. 4. Public Healthcare Services Committee, Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden.
Abstract
PURPOSE: Oral anticoagugulants (OACs) effectively reduce the risk for ischemic stroke in patients with atrial fibrillation (AF), but undertreatment and poor persistence with treatment are important problems. NOACs now provide alternatives to warfarin. This study compares the persistence with presently available antithrombotic treatments in AF patients with a CHA2DS2VASc score ≥2. METHODS: All first claims of either warfarin (n = 9969), dabigatran (n = 2701), rivaroxaban (n = 2074), apixaban (n = 1352), or aspirin (n = 4540) from April 2011 until December 2014, in individuals with non-valvular AF and CHA2DS2VASc scores of 2-9, were identified in the administrative health data register (VAL) of the Stockholm region (2.1 million inhabitants). Prescription claims were analyzed with and without multivariate analysis in relation to age, sex, prescriber category, prior OAC treatment, number of drugs, and death. RESULTS: The overall persistence with any OAC was 88.2% (CI 87.5-88.9) at 1 year and 82.9% (CI 81.8-83.9) at 2 years. After 1 year, the crude persistence was 85.0% (CI 84.2-85.9) with warfarin, 85.9% (CI 81.8-90.1) with apixaban, 74.4% (CI 72.3-76.5) with dabigatran, and 77.4% (CI 74.6-80.2) with rivaroxaban. Multivariate analysis confirmed significantly higher persistence with warfarin and apixaban than with dabigatran or rivaroxaban. The adherence (proportion of days covered >80%) was above 90% for all NOACs; significantly higher with rivaroxaban compared to dabigatran (p < 0.001), but not compared to apixaban (p = 0.14). CONCLUSIONS: After 2 years, the persistence with any anticoagulant treatment was high in patients with non-valvular AF. Our results indicate better persistence with warfarin and apixaban than with dabigatran or rivaroxaban in regular care.
PURPOSE: Oral anticoagugulants (OACs) effectively reduce the risk for ischemic stroke in patients with atrial fibrillation (AF), but undertreatment and poor persistence with treatment are important problems. NOACs now provide alternatives to warfarin. This study compares the persistence with presently available antithrombotic treatments in AFpatients with a CHA2DS2VASc score ≥2. METHODS: All first claims of either warfarin (n = 9969), dabigatran (n = 2701), rivaroxaban (n = 2074), apixaban (n = 1352), or aspirin (n = 4540) from April 2011 until December 2014, in individuals with non-valvular AF and CHA2DS2VASc scores of 2-9, were identified in the administrative health data register (VAL) of the Stockholm region (2.1 million inhabitants). Prescription claims were analyzed with and without multivariate analysis in relation to age, sex, prescriber category, prior OAC treatment, number of drugs, and death. RESULTS: The overall persistence with any OAC was 88.2% (CI 87.5-88.9) at 1 year and 82.9% (CI 81.8-83.9) at 2 years. After 1 year, the crude persistence was 85.0% (CI 84.2-85.9) with warfarin, 85.9% (CI 81.8-90.1) with apixaban, 74.4% (CI 72.3-76.5) with dabigatran, and 77.4% (CI 74.6-80.2) with rivaroxaban. Multivariate analysis confirmed significantly higher persistence with warfarin and apixaban than with dabigatran or rivaroxaban. The adherence (proportion of days covered >80%) was above 90% for all NOACs; significantly higher with rivaroxaban compared to dabigatran (p < 0.001), but not compared to apixaban (p = 0.14). CONCLUSIONS: After 2 years, the persistence with any anticoagulant treatment was high in patients with non-valvular AF. Our results indicate better persistence with warfarin and apixaban than with dabigatran or rivaroxaban in regular care.
Authors: Marsha A Raebel; Julie Schmittdiel; Andrew J Karter; Jennifer L Konieczny; John F Steiner Journal: Med Care Date: 2013-08 Impact factor: 2.983
Authors: Gregory Y H Lip; Cécile Laroche; Popescu Mircea Ioachim; Lars Hvilsted Rasmussen; Laura Vitali-Serdoz; Lucian Petrescu; Dan Darabantiu; Harry J G M Crijns; Paulus Kirchhof; Panos Vardas; Luigi Tavazzi; Aldo P Maggioni; Giuseppe Boriani Journal: Eur Heart J Date: 2014-08-31 Impact factor: 29.983
Authors: Tomas Forslund; Björn Wettermark; Per Wändell; Mia von Euler; Jan Hasselström; Paul Hjemdahl Journal: Eur J Clin Pharmacol Date: 2014-09-16 Impact factor: 2.953
Authors: Supriya Shore; Evan P Carey; Mintu P Turakhia; Cynthia A Jackevicius; Fran Cunningham; Louise Pilote; Steven M Bradley; Thomas M Maddox; Gary K Grunwald; Anna E Barón; John S Rumsfeld; Paul D Varosy; Preston M Schneider; Lucas N Marzec; P Michael Ho Journal: Am Heart J Date: 2014-04-05 Impact factor: 4.749
Authors: Jonas F Ludvigsson; Eva Andersson; Anders Ekbom; Maria Feychting; Jeong-Lim Kim; Christina Reuterwall; Mona Heurgren; Petra Otterblad Olausson Journal: BMC Public Health Date: 2011-06-09 Impact factor: 3.295
Authors: Emily Holthuis; Elisabeth Smits; George Spentzouris; Dominik Beier; Dirk Enders; Rosa Gini; Claudia Bartolini; Giampiero Mazzaglia; Fernie Penning-van Beest; Ron Herings Journal: Drugs Real World Outcomes Date: 2022-07-05
Authors: Joris J Komen; Eibert R Heerdink; Olaf H Klungel; Aukje K Mantel-Teeuwisse; Tomas Forslund; Björn Wettermark; Paul Hjemdahl Journal: Eur Heart J Cardiovasc Pharmacother Date: 2021-04-09
Authors: Elisabeth Smits; Felicita Andreotti; Eline Houben; Harry J G M Crijns; Sylvia Haas; George Spentzouris; Tania Schink; Rosa Gini; Claudia Bartolini; Fernie Penning-van Beest; Ron Herings Journal: Drugs Real World Outcomes Date: 2022-01-06