OXON Epidemiology, Eastside, King's Cross, N1C 4AX London, UK.
Bristol-Myers Squibb, 92500 Rueil-Malmaison, France.
Arch Cardiovasc Dis. 2018 May;111(5):370-379. doi: 10.1016/j.acvd.2017.10.003. Epub 2018 Feb 3.
Oral anticoagulants are prescribed in non-valvular atrial fibrillation for stroke prevention; however, little is known about the current management of anticoagulation in France, particularly given the availability of non-vitamin K antagonist oral anticoagulants in recent years.
To describe the characteristics of patients prescribed oral anticoagulants, and assess treatment persistence in French primary care.
We conducted a cohort study of patients with non-valvular atrial fibrillation, who were newly prescribed oral anticoagulants between 1 January 2014 and 31 January 2016, using French primary care data (IMS Longitudinal Patient Database). Adjusting for baseline characteristics, risk of non-persistence (switch or discontinuation) was compared using Cox regression.
Of 4111 patients, 1710 were newly prescribed vitamin K antagonists, 1257 rivaroxaban, 744 apixaban and 400 dabigatran. The median age was 76 years, and 57.5% were male. History of hypertension was the most common co-morbidity (68.1%). Compared with vitamin K antagonists, non-persistence was higher with rivaroxaban (hazard ratio: 1.28; 95% confidence interval: 1.13-1.45) and dabigatran (hazard ratio: 1.42; 95% confidence interval: 1.20-1.69) and similar with apixaban (hazard ratio: 1.12; 95% confidence interval: 0.96-1.32).
Non-persistence (treatment discontinuation or switch) with vitamin K antagonists was lower than with rivaroxaban and dabigatran in French primary care; however, non-persistence with the newest drug, apixaban, was similar to vitamin K antagonists. Larger studies with longer follow-up are needed to support these findings. This study is registered on ClinicalTrials.gov (NCT02488421).
口服抗凝剂用于预防非瓣膜性心房颤动的中风；然而，目前对法国抗凝治疗的管理情况知之甚少，特别是考虑到近年来非维生素 K 拮抗剂口服抗凝剂的可用性。
描述新接受口服抗凝治疗的非瓣膜性心房颤动患者的特征，并评估法国初级保健中的治疗持续情况。
我们使用法国初级保健数据（IMS 纵向患者数据库），对 2014 年 1 月 1 日至 2016 年 1 月 31 日期间新接受口服抗凝治疗的非瓣膜性心房颤动患者进行了队列研究。根据基线特征进行调整后，使用 Cox 回归比较非持续性（转换或停药）的风险。
在 4111 名患者中，1710 名新处方维生素 K 拮抗剂，1257 名利伐沙班，744 名阿哌沙班和 400 名达比加群。中位年龄为 76 岁，57.5%为男性。高血压病史是最常见的合并症（68.1%）。与维生素 K 拮抗剂相比，利伐沙班（危险比：1.28；95%置信区间：1.13-1.45）和达比加群（危险比：1.42；95%置信区间：1.20-1.69）的非持续性更高，而阿哌沙班（危险比：1.12；95%置信区间：0.96-1.32）相似。
在法国初级保健中，与利伐沙班和达比加群相比，维生素 K 拮抗剂的非持续性（停药或换药）较低；然而，最新药物阿哌沙班的非持续性与维生素 K 拮抗剂相似。需要更大规模、随访时间更长的研究来支持这些发现。这项研究在 ClinicalTrials.gov 注册（NCT02488421）。
