The Persistence of Non-Vitamin K Antagonist Oral Anticoagulants in Korean Patients with Non-Valvular Atrial Fibrillation.
10.18501/arrhythmia.2016.032
- Author:
Choong Sil SEONG
1
;
Hye Bin GWAG
;
Jin Kyung HWANG
;
Seung Jung PARK
;
Kyoung Min PARK
;
June Soo KIM
;
Young Keun ON
Author Information
1. Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. yk.on@samsung.com
- Publication Type:Original Article
- Keywords:
Atrial Fibrillation;
Warfarin;
Medication Persistence;
Treatment Efficacy;
NOAC
- MeSH:
Anticoagulants*;
Atrial Fibrillation*;
Follow-Up Studies;
Hemorrhage;
Humans;
Medication Adherence;
Retrospective Studies;
Rivaroxaban;
Stroke;
Treatment Outcome;
Warfarin
- From:International Journal of Arrhythmia
2016;17(4):190-199
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND OBJECTIVES: Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), showing better efficacy and safety than warfarin. However, the rates or reasons for discontinuation of NOACs in clinical practice have not been clarified. The aim of this study was to compare 3 NOACs (apixaban, rivaroxaban, and dabigatran) with warfarin in terms of medication persistence. SUBJECTS AND METHODS: We retrospectively evaluated 1,527 patients with NVAF who had recently started taking NOACs between January 2012 and September 2015 (294 apixaban, 748 rivaroxaban, and 485 dabigatran) and compared them with 363 patients with NVAF who started taking warfarin between January 2012 and December 2013 at the Samsung Medical Center. RESULTS: The mean follow-up duration was 532 days. The discontinuation rates were higher in the 3 NOAC groups than in the warfarin group within the first year. The major causes of discontinuation were maintenance of sinus rhythm; adverse events, including all bleeding and gastrointestinal symptoms; and patients demand. The adverse event rate was lower in the warfarin group than in the 3 NOAC groups. No significant differences in thromboembolic and major bleeding events were found between the 3 NOAC groups and the warfarin group. CONCLUSION: In a single-center study, NOACs showed lower medication persistence and higher adverse event rates than warfarin during the first year.
