University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
PLoS One. 2018 Apr 30;13(4):e0195950. doi: 10.1371/journal.pone.0195950. eCollection 2018.
Discontinuation of oral anticoagulants may expose non-valvular atrial fibrillation (NVAF) patients to an increased risk of stroke. This study describes the real-world discontinuation rates and compared the risk of drug discontinuation among NVAF patients initiating apixaban, warfarin, dabigatran, or rivaroxaban. This retrospective cohort study evaluated newly-anticoagulated NVAF patients in the MarketScan® data population from 01/01/2012 through 12/31/2014. Discontinuation was defined as a lack of subsequent prescription of the index drug within 30 days after the last supply day of the last prescription. A Cox model was used to estimate the hazard ratio (HR) of discontinuation, adjusted for age, sex, and comorbidities. Among 45,361 eligible NVAF patients, 15,461 (34.1%) initiated warfarin; 7,438 (16.4%) apixaban; 4,661 (10.3%) dabigatran; and 17,801 (39.2%) initiated rivaroxaban treatment. Compared to warfarin, patients who initiated dabigatran (adjusted HR [aHR]: 0.84, 95% confidence interval [CI]: 0.80-0.87, P<0.001), rivaroxaban (aHR: 0.70, 95% CI: 0.68-0.73, P<0.001), or apixaban (aHR: 0.57, 95% CI: 0.55-0.60, P<0.001) were 16%, 30%, and 43% less likely to discontinue treatment, respectively. When compared to apixaban, patients who initiated dabigatran (aHR: 1.46, 95% CI: 1.38-1.54, P<0.001) or rivaroxaban (aHR: 1.23, 95% CI: 1.17-1.28, P<0.001) were more likely to discontinue treatment. Among newly-anticoagulated NVAF patients in the real-world setting, initiation on rivaroxaban, dabigatran, or apixaban was associated with a significantly lower risk of discontinuation compared to warfarin. When compared to apixaban, patients who initiated treatment with warfarin, dabigatran, or rivaroxaban were more likely to discontinue treatment.
停用口服抗凝药物可能会使非瓣膜性心房颤动（NVAF）患者面临更高的中风风险。本研究描述了真实世界中 NVAF 患者停用依诺肝素、华法林、达比加群或利伐沙班的停药率，并比较了 NVAF 患者开始使用阿哌沙班、华法林、达比加群或利伐沙班的停药风险。本回顾性队列研究评估了 2012 年 1 月 1 日至 2014 年 12 月 31 日 MarketScan 数据人群中接受新抗凝治疗的 NVAF 患者。停药定义为在最后一次处方的最后供应日后 30 天内没有后续开具索引药物。使用 Cox 模型估计停药的风险比（HR），调整年龄、性别和合并症。在 45361 名符合条件的 NVAF 患者中，15461 名（34.1%）开始使用华法林；7438 名（16.4%）阿哌沙班；4661 名（10.3%）达比加群；17801 名（39.2%）开始利伐沙班治疗。与华法林相比，开始使用达比加群（调整后的 HR[aHR]：0.84，95%置信区间[CI]：0.80-0.87，P<0.001）、利伐沙班（aHR：0.70，95% CI：0.68-0.73，P<0.001）或阿哌沙班（aHR：0.57，95% CI：0.55-0.60，P<0.001）的患者停药的可能性分别降低 16%、30%和 43%。与阿哌沙班相比，开始使用达比加群（aHR：1.46，95% CI：1.38-1.54，P<0.001）或利伐沙班（aHR：1.23，95% CI：1.17-1.28，P<0.001）的患者停药的可能性更高。在真实世界环境中接受新抗凝治疗的 NVAF 患者中，与华法林相比，开始使用利伐沙班、达比加群或阿哌沙班与停药风险显著降低相关。与阿哌沙班相比，开始使用华法林、达比加群或利伐沙班的患者停药的可能性更高。
