Simons Leon A, Ortiz Michael, Freedman Ben, Waterhouse Benjamin J, Colquhoun David
a UNSW Lipid Research Department , St Vincent's Hospital , Darlinghurst , NSW , Australia.
b UNSW St Vincent's Clinical School, Darlinghurst, NSW and Zitro Consulting Services , Sydney , Australia.
Curr Med Res Opin. 2017 Jul;33(7):1337-1341. doi: 10.1080/03007995.2017.1321535. Epub 2017 May 10.
Long-term anticoagulant therapy with non-valvular atrial fibrillation (AF) is essential to prevent thromboembolic complications, especially ischemic stroke. This study examines medium-term persistence in AF patients using a non-vitamin-K antagonist oral anticoagulant drug (NOAC).
We assessed national Pharmaceutical Benefit Scheme records December 2013 through September 2016 for initial prescription of a NOAC in a 10% random sample of concessional patients. Key outcome measures were: (a) proportions filling first repeat prescription, (b) proportions persisting with NOAC over 12 and 30 months and (c) proportions switching to another NOAC or warfarin.
A total of 8656 patients with AF initiated a NOAC (3352 apixaban, 1340 dabigatran, 3964 rivaroxaban). Mean age was 77 years, 53% male; 91% collected the first repeat prescription for any NOAC, 70% and 57% collected any NOAC or subsequent warfarin prescription over 12 months and 30 months respectively; 8.9% had switched to warfarin. The proportions switching from apixaban, dabigatran and rivaroxaban to a different NOAC were 14%, 31% and 17% respectively. In a regression model adjusting for age, gender and comorbidity, apixaban-initiated patients over 30 months were 28% more likely to persist with any anticoagulant therapy compared with dabigatran-initiated patients (hazard ratio [95% CI] 1.28 [1.16-1.42]) and 15% more likely to persist compared with rivaroxaban-initiated (1.15 [1.06-1.24]). Rivaroxaban-initiated patients were 12% more likely to persist compared with dabigatran-initiated patients (1.12 [1.02-1.24]).
Long-term persistence with anticoagulation in patients with AF remains a concern, even with NOACs. Patients initiated to apixaban appear to experience better medium-term persistence compared with rivaroxaban or dabigatran.
对于非瓣膜性心房颤动（AF）患者，长期抗凝治疗对于预防血栓栓塞并发症，尤其是缺血性卒中至关重要。本研究考察了使用非维生素K拮抗剂口服抗凝药（NOAC）的AF患者的中期持续性。
我们评估了2013年12月至2016年9月期间国家药品福利计划记录，这些记录来自10%的特惠患者随机样本中首次开具NOAC的情况。主要结局指标为：（a）首次重复配药的比例，（b）12个月和30个月时持续使用NOAC的比例，以及（c）换用另一种NOAC或华法林的比例。
共有8656例AF患者开始使用NOAC（3352例使用阿哌沙班，1340例使用达比加群，3964例使用利伐沙班）。平均年龄为77岁，男性占53%；91%的患者领取了任何NOAC的首次重复处方，12个月和30个月时分别有70%和57%的患者领取了任何NOAC或后续的华法林处方；8.9%的患者换用了华法林。从阿哌沙班、达比加群和利伐沙班换用另一种NOAC的比例分别为14%、31%和17%。在调整年龄、性别和合并症的回归模型中，与使用达比加群起始治疗的患者相比，使用阿哌沙班起始治疗超过30个月的患者持续接受任何抗凝治疗的可能性高28%（风险比[95%CI]1.28[1.16 - 1.42]），与使用利伐沙班起始治疗的患者相比持续接受治疗的可能性高15%（1.15[1.06 - 1.24]）。与使用达比加群起始治疗的患者相比，使用利伐沙班起始治疗的患者持续接受治疗的可能性高12%（1.12[1.02 - 1.24]）。
即使使用NOAC，AF患者抗凝治疗的长期持续性仍然是一个问题。与利伐沙班或达比加群相比，起始使用阿哌沙班的患者似乎中期持续性更好。
