Miney Paquette1, Lionel Riou França2, Christine Teutsch3, Hans-Christoph Diener4, Shihai Lu5, Sergio J Dubner6, Chang Sheng Ma7, Kenneth J Rothman8, Kristina Zint2, Jonathan L Halperin9, Menno V Huisman10, Gregory Y H Lip11, Robby Nieuwlaat12. 1. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Boehringer Ingelheim Ltd., Burlington, Ontario, Canada. Electronic address: miney.paquette@boehringer-ingelheim.com. 2. Department of Epidemiology, Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany. 3. Department of Medicine, Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany. 4. Department of Neurology, University Hospital Essen, Essen, Germany. 5. Department of Biostatistics and Data Sciences, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut. 6. Department of Cardiology, Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina. 7. Department of Cardiology, Atrial Fibrillation Center, Beijing Anzhen Hospital, Beijing, China. 8. RTI Health Solutions, Research Triangle Park, Durham, North Carolina. 9. Icahn School of Medicine at Mount Sinai, Mount Sinai School of Medicine, New York, New York. 10. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 11. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 12. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Abstract
BACKGROUND: Guidelines recommend long-term oral anticoagulation therapy for stroke prevention in patients with atrial fibrillation (AF). Treatment discontinuation rates in vitamin K antagonist (VKA)-treated patients are high but may be lower with non-VKA oral anticoagulant agents. OBJECTIVES: The goal of this study was to describe and explore predictors of dabigatran etexilate persistence in patients with newly diagnosed AF over 2 years of follow-up. METHODS: Consecutive patients newly diagnosed with AF and ≥1 stroke risk factor were followed up for 2 years. Dabigatran nonpersistence was defined as discontinuation of dabigatran for >30 days. A multivariable Cox regression model included region as well as patient clinical and sociodemographic characteristics to explore predictors of nonpersistence. RESULTS: Eligible patients (N = 2,932) took ≥1 dabigatran dose; their mean age was 70.3 ± 10.2 years, and 55.3% were male. The 2-year probability of dabigatran persistence was 69.2%. Approximately 7% switched to a factor Xa inhibitor and 6% to a VKA. Approximately one-third of dabigatran discontinuations were primarily due to serious or nonserious adverse events. Patients from North America had the highest discontinuation risk, and Latin America had the lowest. Minimally symptomatic or asymptomatic AF and permanent AF were associated with a lower risk for dabigatran nonpersistence. Previous proton pump inhibitor use was associated with a higher risk for dabigatran nonpersistence. CONCLUSIONS: Probability of treatment persistence with dabigatran after 2 years was approximately 70%. Nearly one-half of the patients who stopped dabigatran switched to another oral anticoagulant agent. Patients from North America, and those with paroxysmal, persistent, or symptomatic AF, may be at a higher risk for discontinuing dabigatran.
BACKGROUND: Guidelines recommend long-term oral anticoagulation therapy for stroke prevention in patients with atrial fibrillation (AF). Treatment discontinuation rates in vitamin K antagonist (VKA)-treated patients are high but may be lower with non-VKA oral anticoagulant agents. OBJECTIVES: The goal of this study was to describe and explore predictors of dabigatran etexilate persistence in patients with newly diagnosed AF over 2 years of follow-up. METHODS: Consecutive patients newly diagnosed with AF and ≥1 stroke risk factor were followed up for 2 years. Dabigatran nonpersistence was defined as discontinuation of dabigatran for >30 days. A multivariable Cox regression model included region as well as patient clinical and sociodemographic characteristics to explore predictors of nonpersistence. RESULTS: Eligible patients (N = 2,932) took ≥1 dabigatran dose; their mean age was 70.3 ± 10.2 years, and 55.3% were male. The 2-year probability of dabigatran persistence was 69.2%. Approximately 7% switched to a factor Xa inhibitor and 6% to a VKA. Approximately one-third of dabigatran discontinuations were primarily due to serious or nonserious adverse events. Patients from North America had the highest discontinuation risk, and Latin America had the lowest. Minimally symptomatic or asymptomatic AF and permanent AF were associated with a lower risk for dabigatran nonpersistence. Previous proton pump inhibitor use was associated with a higher risk for dabigatran nonpersistence. CONCLUSIONS: Probability of treatment persistence with dabigatran after 2 years was approximately 70%. Nearly one-half of the patients who stopped dabigatran switched to another oral anticoagulant agent. Patients from North America, and those with paroxysmal, persistent, or symptomatic AF, may be at a higher risk for discontinuing dabigatran.
Authors: Larry R Jackson; Sunghee Kim; Peter Shrader; Rosalia Blanco; Laine Thomas; Michael D Ezekowitz; Jack Ansell; Gregg C Fonarow; Bernard J Gersh; Alan S Go; Peter R Kowey; Kenneth W Mahaffey; Elaine M Hylek; Eric D Peterson; Jonathan P Piccini Journal: J Thromb Thrombolysis Date: 2018-11 Impact factor: 2.300
Authors: P P Olimpieri; A Di Lenarda; F Mammarella; L Gozzo; A Cirilli; M Cuomo; M M Gulizia; F Colivicchi; G Murri; D Gabrielli; F Trotta Journal: Int J Cardiol Heart Vasc Date: 2020-01-23
Authors: Gilda Denise Zielinski; Nienke van Rein; Martina Teichert; Frederikus A Klok; Frits R Rosendaal; Felix J M van der Meer; Menno V Huisman; Suzanne C Cannegieter; Willem M Lijfering Journal: Res Pract Thromb Haemost Date: 2019-10-24
Authors: Amitava Banerjee; Valerio Benedetto; Philip Gichuru; Jane Burnell; Sotiris Antoniou; Richard J Schilling; William David Strain; Ronan Ryan; Caroline Watkins; Tom Marshall; Chris J Sutton Journal: Heart Date: 2019-10-10 Impact factor: 5.994
Authors: Maxim Grymonprez; Andreas Capiau; Stephane Steurbaut; Els Mehuys; Koen Boussery; Tine L De Backer; Lies Lahousse Journal: Front Cardiovasc Med Date: 2022-09-29
Authors: Sergio Dubner; José Francisco Kerr Saraiva; Juan Carlos Nunez Fragoso; Gonzalo Barón-Esquivias; Christine Teutsch; Venkatesh Kumar Gurusamy; Sabrina Marler; Menno V Huisman; Gregory Y H Lip; Cecilia Zeballos Journal: Int J Cardiol Heart Vasc Date: 2020-11-03
Authors: Frank Cools; Dana Johnson; Alan J Camm; Jean-Pierre Bassand; Freek W A Verheugt; Shu Yang; Anastasios Tsiatis; David A Fitzmaurice; Samuel Z Goldhaber; Gloria Kayani; Shinya Goto; Sylvia Haas; Frank Misselwitz; Alexander G G Turpie; Keith A A Fox; Karen S Pieper; Ajay K Kakkar Journal: J Thromb Haemost Date: 2021-07-23 Impact factor: 5.824