Kachroo Sumesh, Hamilton Melissa, Liu Xianchen, Pan Xianying, Brixner Diana, Marrouche Nassir, Biskupiak Joseph
University of Utah College of Pharmacy, L.S. Skaggs Pharmacy Institute, 30 South 2000 East, Rm 4962, Salt Lake City, UT 84112. E-mail:
Am J Manag Care. 2016 Jan 1;22(1):e1-8.
To identify factors associated with all-cause discontinuation (patient discontinued on their own or physician discontinuation) of oral anticoagulants (OACs) among nonvalvular atrial fibrillation (NVAF) patients.
Retrospective cohort study.
We analyzed the MarketScan claims database from October 2009 to July 2012. Adult patients were eligible if they newly initiated an OAC in the study period, had an atrial fibrillation diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification code 427.31 or 472.32), and had at least 6 months of continuous enrollment after OAC initiation. Multivariable Cox proportional hazards regression was used to assess factors associated with discontinuation. Adjusted hazard ratios (HRs) and 95% CIs were reported.
Among 12,129 eligible patients, 8143 (67.1%) initiated warfarin and 3986 (32.9%) initiated direct oral anticoagulants (DOACs). Overall, 47.3% of patients independently discontinued during follow-up (mean number of days of follow-up = 416.6 [SD ± 141.7]) with mean time to discontinuation of 120 days (SD ± 114.7). Patients significantly less likely to discontinue included those taking DOACs versus warfarin (HR, 0.91; 95% CI, 0.86-0.97), older patients (≥65 years vs 18 to 34 years) (HR, 0.32; 95% CI, 0.24-0.43), those with diabetes (HR, 0.84; 95% CI, 0.77-0.90), those with prior stroke/transient ischemic attack (HR, 0.65; 95% CI, 0.56-0.75), those with prior pulmonary embolism (HR, 0.71; 95% CI, 0.58-0.88), and those with congestive heart failure (HR, 0.80; 95% CI, 0.74-0.87). Patients with prior bleeding events were significantly more likely to independently discontinue (HR, 1.20; 95% CI, 1.08-1.34).
The risk of independent discontinuation of OAC treatment among NVAF patients was high. Patients on DOACs compared with warfarin and those with several comorbid conditions had significantly lower risk of discontinuation, while those with prior bleeding were more likely to discontinue.
确定非瓣膜性心房颤动（NVAF）患者中与口服抗凝药（OAC）全因停药（患者自行停药或医生停药）相关的因素。
回顾性队列研究。
我们分析了2009年10月至2012年7月的MarketScan索赔数据库。成年患者若在研究期间新开始使用OAC、有房颤诊断（国际疾病分类第九版临床修订本代码427.31或472.32）且在开始使用OAC后至少连续登记6个月，则符合入选标准。采用多变量Cox比例风险回归评估与停药相关的因素。报告调整后的风险比（HR）和95%置信区间（CI）。
在12129名符合条件的患者中，8143名（67.1%）开始使用华法林，3986名（32.9%）开始使用直接口服抗凝药（DOAC）。总体而言，47.3%的患者在随访期间自行停药（平均随访天数 = 416.6 [标准差±141.7]），平均停药时间为120天（标准差±114.7）。停药可能性显著较低的患者包括服用DOAC的患者与服用华法林的患者相比（HR，0.91；95% CI，0.86 - 0.97）、老年患者（≥65岁与18至34岁相比）（HR，0.32；95% CI，0.24 - 0.43）、患有糖尿病的患者（HR，0.84；95% CI，0.77 - 0.90）、有既往卒中/短暂性脑缺血发作的患者（HR，0.65；95% CI，0.56 - 0.75）、有既往肺栓塞的患者（HR，0.71；95% CI，0.58 - 0.88）以及患有充血性心力衰竭的患者（HR，0.80；95% CI，0.74 - 0.87）。有既往出血事件的患者自行停药的可能性显著更高（HR，1.20；95% CI，1.08 -
