Stefan H Hohnloser1, Edin Basic2, Michael Nabauer3. 1. Division of Clinical Electrophysiology, Department of Cardiology, Johann Wolfgang Goethe University, Frankfurt, Germany. 2. Pfizer Deutschland GmbH, Berlin, Germany. 3. Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany.
Abstract
BACKGROUND: This study assessed changes in anticoagulation therapy over time in patients with atrial fibrillation (AF). METHODS: Analyses were performed on a claims-based dataset of 4 million health-insured individuals. The study population consisted of patients newly initiating a non-vitamin-K oral anticoagulants (NOACs) or vitamin K antagonist (VKA) for AF between 2013 and 2016. The study outcomes consisted of the proportion of patients who had (1) discontinued OAC treatment, (2) switched from VKA to NOAC, (3) switched from NOAC to VKA or (4) switched from one NOAC to another. Predictors of discontinuation or switching of OAC treatment were determined by Cox proportional hazards regression models with time-independent and time-dependent covariates. RESULTS: The study population comprised 51,606 AF patients initiating VKA (n = 21,468, 41.6%), apixaban (n = 8,832, 17.1%), dabigatran (n = 3,973, 7.7%) or rivaroxaban (n = 17,333, 33.6%). After 1 year, 29.9% of VKA and 29.5% of NOAC patients had discontinued OAC treatment without switching to another anticoagulant. A total of 10.7% of VKA patients switched to NOACs within 1 year, whereas 4.9% NOAC patients had switched to VKA. Of AF patients who were initiated on a NOAC, 5.2% switched to another NOAC. Treatment changes among NOAC starters were strongly associated with occurrence of stroke, myocardial infarction and gastrointestinal bleeding after treatment initiation. For VKA starters switching to a NOAC, stroke and bleeding events were associated with an increased likelihood of switching. CONCLUSION: Overall discontinuation rates of VKA and NOACs are comparable over the first year of therapy, while switching from VKA to NOAC was more common than from NOAC to VKA. The majority of treatment changes were associated with clinical events. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: This study assessed changes in anticoagulation therapy over time in patients with atrial fibrillation (AF). METHODS: Analyses were performed on a claims-based dataset of 4 million health-insured individuals. The study population consisted of patients newly initiating a non-vitamin-K oral anticoagulants (NOACs) or vitamin K antagonist (VKA) for AF between 2013 and 2016. The study outcomes consisted of the proportion of patients who had (1) discontinued OAC treatment, (2) switched from VKA to NOAC, (3) switched from NOAC to VKA or (4) switched from one NOAC to another. Predictors of discontinuation or switching of OAC treatment were determined by Cox proportional hazards regression models with time-independent and time-dependent covariates. RESULTS: The study population comprised 51,606 AFpatients initiating VKA (n = 21,468, 41.6%), apixaban (n = 8,832, 17.1%), dabigatran (n = 3,973, 7.7%) or rivaroxaban (n = 17,333, 33.6%). After 1 year, 29.9% of VKA and 29.5% of NOACpatients had discontinued OAC treatment without switching to another anticoagulant. A total of 10.7% of VKA patients switched to NOACs within 1 year, whereas 4.9% NOACpatients had switched to VKA. Of AFpatients who were initiated on a NOAC, 5.2% switched to another NOAC. Treatment changes among NOAC starters were strongly associated with occurrence of stroke, myocardial infarction and gastrointestinal bleeding after treatment initiation. For VKA starters switching to a NOAC, stroke and bleeding events were associated with an increased likelihood of switching. CONCLUSION: Overall discontinuation rates of VKA and NOACs are comparable over the first year of therapy, while switching from VKA to NOAC was more common than from NOAC to VKA. The majority of treatment changes were associated with clinical events. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Bianca J J M Brundel; Xun Ai; Mellanie True Hills; Myrthe F Kuipers; Gregory Y H Lip; Natasja M S de Groot Journal: Nat Rev Dis Primers Date: 2022-04-07 Impact factor: 52.329
Authors: Aissa Bah; Ilpo Nuotio; Antti Palomäki; Pirjo Mustonen; Tuomas Kiviniemi; Antti Ylitalo; Päivi Hartikainen; K E Juhani Airaksinen; Juha E K Hartikainen Journal: Ann Med Date: 2021-12 Impact factor: 4.709
Authors: Christian Fastner; Kristina Szabo; Melina Samartzi; Mathieu Kruska; Ibrahim Akin; Michael Platten; Stefan Baumann; Angelika Alonso Journal: PLoS One Date: 2022-02-17 Impact factor: 3.240
Authors: Myrthe M A Toorop; Nienke van Rein; Melchior C Nierman; Helga W Vermaas; Menno V Huisman; Felix J M van der Meer; Suzanne C Cannegieter; Willem M Lijfering Journal: Res Pract Thromb Haemost Date: 2020-03-14