The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF)

  • Kim, Hyeongsoo (Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Lee, Young Soo (Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center) ;
  • Kim, Tae-Hoon (Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Cha, Myung-Jin (Department of Internal Medicine, Seoul National University Hospital) ;
  • Lee, Jung Myung (Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital) ;
  • Park, Junbeom (Department of Cardiology, Ewha Womans University School of Medicine) ;
  • Park, Jin-Kyu (Department of Cardiology, Hanyang University Seoul Hospital) ;
  • Kang, Ki-Woon (Division of Cardiology, Department of Internal Medicine, Eulji University Hospital) ;
  • Shim, Jaemin (Division of Cardiology, Department of Internal Medicine, Korea University Medical Center) ;
  • Uhm, Jae-Sun (Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Park, Hyung Wook (Department of Cardiology, Chonnam National University Hospital) ;
  • Choi, Eue-Keun (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Jin-Bae (Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital) ;
  • Kim, Changsoo (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Kim, Jun (Heart Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Joung, Boyoung (Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine)
  • Received : 2018.05.29
  • Accepted : 2018.07.10
  • Published : 2020.01.01
⟨ Previous Next ⟩

Abstract

Background/Aims: Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are more convenient to administer than warfarin, their lack of monitoring may predispose patients to nonpersistence. We compared the persistence of NOAC and VKA treatment for AF in real-world practice. Methods: In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 7,013 patients with nonvalvular AF (mean age 67.2 ± 10.9 years, women 36.4%) were consecutively enrolled between June 2016 and June 2017 from 10 tertiary hospitals in Korea. This study included 3,381 patients who started OAC 30 days before enrollment (maintenance group) and 572 patients who newly started OAC (new-starter group). The persistence rate of OAC was evaluated. Results: In the maintenance group, persistence to OAC declined during 6 months, to 88.3% for VKA and 95.5% for NOAC (p < 0.0001). However, the persistence rate was not different among NOACs. In the new-starter group, persistence to OAC declined during 6 months, to 78.9% for VKA and 92.1% for NOAC (p < 0.0001). The persistence rate was lower for rivaroxaban (83.7%) than apixaban (94.6%) and edoxaban (94.1%, p < 0.001). In the new-starter group, diabetes, valve disease, and cancer were related to nonpersistence of OAC. Conclusions: Nonpersistence was significantly lower with NOAC than VKA in both the maintenance and new-starter groups. In only the new-starter group, apixaban or edoxaban showed higher persistence rates than rivaroxaban.

Keywords

Acknowledgement

This study was supported by research grants from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2017R1A2B3003303), and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health and Welfare (HI16C0058 and HI15C1200).

References

  1. Lee H, Kim TH, Baek YS, et al. The trends of atrial fibrillation-related hospital visit and cost, treatment pattern and mortality in Korea: 10-year nationwide sample cohort data. Korean Circ J 2017;47:56-64. https://doi.org/10.4070/kcj.2016.0045
  2. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014;130:e199-e267.
  3. Kim TH, Yang PS, Uhm JS, et al. CHA(2)DS(2)-VASc score (congestive heart failure, hypertension, age ≥75 [doubled], diabetes mellitus, prior stroke or transient ischemic attack [doubled], vascular disease, age 65-74, female) for stroke in Asian patients with atrial fibrillation: a Korean nationwide sample cohort study. Stroke 2017;48:1524-1530. https://doi.org/10.1161/STROKEAHA.117.016926
  4. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146:857-867. https://doi.org/10.7326/0003-4819-146-12-200706190-00007
  5. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-1151. https://doi.org/10.1056/NEJMoa0905561
  6. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883-891. https://doi.org/10.1056/NEJMoa1009638
  7. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955-962. https://doi.org/10.1016/S0140-6736(13)62343-0
  8. Camm AJ, Lip GY, De Caterina R, et al. 2012 Focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012;33:2719-2747. https://doi.org/10.1093/eurheartj/ehs253
  9. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014;64:e1-e76. https://doi.org/10.1016/j.jacc.2014.03.022
  10. You JJ, Singer DE, Howard PA, et al. Antithrombotic therapy for atrial fibrillation: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141(2 Suppl):e531S-e575S. https://doi.org/10.1378/chest.11-2304
  11. Nelson WW, Song X, Coleman CI, et al. Medication persistence and discontinuation of rivaroxaban versus warfarin among patients with non-valvular atrial fibrillation. Curr Med Res Opin 2014;30:2461-2469. https://doi.org/10.1185/03007995.2014.933577
  12. Shore S, Ho PM, Lambert-Kerzner A, et al. Site-level variation in and practices associated with dabigatran adherence. JAMA 2015;313:1443-1450. https://doi.org/10.1001/jama.2015.2761
  13. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013;369:2093-2104. https://doi.org/10.1056/NEJMoa1310907
  14. Tsai K, Erickson SC, Yang J, Harada AS, Solow BK, Lew HC. Adherence, persistence, and switching patterns of dabigatran etexilate. Am J Manag Care 2013;19:e325-e332.
  15. Michel J, Mundell D, Boga T, Sasse A. Dabigatran for anticoagulation in atrial fibrillation: early clinical experience in a hospital population and comparison to trial data. Heart Lung Circ 2013;22:50-55. https://doi.org/10.1016/j.hlc.2012.09.002
  16. Zalesak M, Siu K, Francis K, et al. Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin. Circ Cardiovasc Qual Outcomes 2013;6:567-574. https://doi.org/10.1161/CIRCOUTCOMES.113.000192
  17. Shore S, Carey EP, Turakhia MP, et al. Adherence to dabigatran therapy and longitudinal patient outcomes: insights from the veterans health administration. Am Heart J 2014;167:810-817. https://doi.org/10.1016/j.ahj.2014.03.023
  18. Laliberte F, Cloutier M, Nelson WW, et al. Real-world comparative effectiveness and safety of rivaroxaban and warfarin in nonvalvular atrial fibrillation patients. Curr Med Res Opin 2014;30:1317-1325. https://doi.org/10.1185/03007995.2014.907140
  19. Witt DM. Approaches to optimal dosing of vitamin K antagonists. Semin Thromb Hemost 2012;38:667-672. https://doi.org/10.1055/s-0032-1324713
  20. Patel MR, Hellkamp AS, Lokhnygina Y, et al. Outcomes of discontinuing rivaroxaban compared with warfarin in patients with nonvalvular atrial fibrillation: analysis from the ROCKET AF trial (Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation). J Am Coll Cardiol 2013;61:651-658. https://doi.org/10.1016/j.jacc.2012.09.057
  21. Beyer-Westendorf J, Forster K, Ebertz F, et al. Drug persistence with rivaroxaban therapy in atrial fibrillation patients-results from the Dresden non-interventional oral anticoagulation registry. Europace 2015;17:530-538. https://doi.org/10.1093/europace/euu319
  22. Gorst-Rasmussen A, Skjoth F, Larsen TB, Rasmussen LH, Lip GY, Lane DA. Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study. J Thromb Haemost 2015;13:495-504. https://doi.org/10.1111/jth.12845
  23. Forslund T, Wettermark B, Hjemdahl P. Comparison of treatment persistence with different oral anticoagulants in patients with atrial fibrillation. Eur J Clin Pharmacol 2016;72:329-338. https://doi.org/10.1007/s00228-015-1983-z
  24. Yao X, Abraham NS, Alexander GC, et al. Effect of adherence to oral anticoagulants on risk of stroke and major bleeding among patients with atrial fibrillation. J Am Heart Assoc 2016;5:e003074.
  25. Fang MC, Go AS, Chang Y, et al. Warfarin discontinuation after starting warfarin for atrial fibrillation. Circ Cardiovasc Qual Outcomes 2010;3:624-631. https://doi.org/10.1161/CIRCOUTCOMES.110.937680
  26. Gomes T, Mamdani MM, Holbrook AM, Paterson JM, Juurlink DN. Persistence with therapy among patients treated with warfarin for atrial fibrillation. Arch Intern Med 2012;172:1687-1689. https://doi.org/10.1001/archinternmed.2012.4485
  27. Jackevicius CA, Tsadok MA, Essebag V, et al. Early non-persistence with dabigatran and rivaroxaban in patients with atrial fibrillation. Heart 2017;103:1331-1338. https://doi.org/10.1136/heartjnl-2016-310672
  28. Johnson ME, Lefevre C, Collings SL, et al. Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care. BMJ Open 2016;6:e011471. https://doi.org/10.1136/bmjopen-2016-011471
  29. Collings SL, Lefevre C, Johnson ME, et al. Oral anticoagulant persistence in patients with non-valvular atrial fibrillation: a cohort study using primary care data in Germany. PLoS One 2017;12:e0185642. https://doi.org/10.1371/journal.pone.0185642
  30. Rubboli A. Adherence to and persistence with non-vitamin K-antagonist oral anticoagulants: does the number of pills per day matter? Curr Med Res Opin 2015;31:1845-1847. https://doi.org/10.1185/03007995.2015.1086993
  31. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001;23:1296-1310. https://doi.org/10.1016/S0149-2918(01)80109-0
  32. Beyer-Westendorf J, Ehlken B, Evers T. Real-world persistence and adherence to oral anticoagulation for stroke risk reduction in patients with atrial fibrillation. Europace 2016;18:1150-1157. https://doi.org/10.1093/europace/euv421
  33. Shiga T, Naganuma M, Nagao T, et al. Persistence of non-vitamin K antagonist oral anticoagulant use in Japanese patients with atrial fibrillation: a single-center observational study. J Arrhythm 2015;31:339-344. https://doi.org/10.1016/j.joa.2015.04.004
  34. Lane DA, Lip GY. Patient's values and preferences for stroke prevention in atrial fibrillation: balancing stroke and bleeding risk with oral anticoagulation. Thromb Haemost 2014;111:381-383. https://doi.org/10.1160/TH14-01-0063
  35. Lahaye S, Regpala S, Lacombe S, et al. Evaluation of patients' attitudes towards stroke prevention and bleeding risk in atrial fibrillation. Thromb Haemost 2014;111:465-473. https://doi.org/10.1160/TH13-05-0424

Cited by

  1. How to maintain an adherence to oral anticoagulant in a patient with atrial fibrillation? vol.59, pp.11, 2020, https://doi.org/10.18087/cardio.2019.11.n724
  2. Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy vol.10, pp.1, 2020, https://doi.org/10.3390/jcm10010083
  3. Patient characteristics, adherence, and costs of oral anticoagulation therapy in non-valvular atrial fibrillation using the Dubai Real-World Claims Database vol.11, pp.2, 2020, https://doi.org/10.4103/ajm.ajm_228_20
  4. The importance of adherence and persistence with oral anticoagulation treatment in patients with atrial fibrillation vol.7, pp.fi1, 2021, https://doi.org/10.1093/ehjcvp/pvaa020
  5. Edoxaban for stroke prevention in atrial fibrillation in routine clinical care: 1-year follow-up of the prospective observational ETNA-AF-Europe study vol.7, pp.fi1, 2020, https://doi.org/10.1093/ehjcvp/pvaa079
  6. 2021 Focused update of the 2017 consensus guidelines of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation vol.37, pp.6, 2021, https://doi.org/10.1002/joa3.12652