Komócsi András
a Department of Interventional Cardiology , Heart Institute, University of Pécs , Pécs , Hungary.
Curr Med Res Opin. 2015;31(10):1841-4. doi: 10.1185/03007995.2015.1086991. Epub 2015 Sep 14.
The new generation, non-vitamin K antagonist oral anticoagulants are used in an increasing frequency, partially replacing the vitamin K antagonists in several fields of anticoagulation. Efficacy of the preventive oral anticoagulant regime, however, may be compromised by patient non-compliance.
The authors analyzed treatment discontinuation frequencies in phase 3 trials of anticoagulant treatment in non-valvular atrial fibrillation in a frequentist random effect metaanalysis and in Bayesian multiple treatment network comparison.
Frequency of discontinuations are heterogeneous and highly inconsistent (Chi2 test for heterogeneity p < 0.001, I2 test for inconsistency 95.1%). Discontinuations were the most frequent with dabigatran followed by rivaroxaban, warfarin, edoxaban and apixaban. Rivaroxaban were less frequently discontinued when compared to the two doses of dabigatran. (OR 0.80; 95% CI: 0.71-0.91 versus 150 mg b.i.d., and OR: 0.77; 95% CI: 0.68-0.87 versus 110 mg b.i.d.).
Important differences exist among the treatment adherence of different anticoagulant protocols. Discontinuation rates experienced during the clinical trials may predict the real life patient adherence.
新一代非维生素K拮抗剂口服抗凝药的使用频率日益增加，在多个抗凝领域部分取代了维生素K拮抗剂。然而，预防性口服抗凝方案的疗效可能会因患者不依从而受到影响。
作者在一个频率学派随机效应荟萃分析和贝叶斯多治疗网络比较中，分析了非瓣膜性心房颤动抗凝治疗3期试验中的治疗中断频率。
中断频率具有异质性且高度不一致（异质性的卡方检验p < 0.001，不一致性的I2检验95.1%）。达比加群的中断最为频繁，其次是利伐沙班、华法林、依度沙班和阿哌沙班。与两种剂量的达比加群相比，利伐沙班的中断频率较低。（与150毫克每日两次相比，OR 0.80；95% CI：0.71 - 0.91；与110毫克每日两次相比，OR：0.77；95% CI：0.68 - 0.87）。
不同抗凝方案的治疗依从性存在重要差异。临床试验期间经历的中断率可能预测现实生活中患者的依从性。
