Simonyi Gábor, Ferenci Tamás, Finta Ervin, Gasparics Roland, Medvegy Mihály
Anyagcsere Központ, Szent Imre Egyetemi Oktatókórház Budapest, Tétényi út 12-16., 1115.
Élettani Szabályozások Csoport, Óbudai Egyetem, Neumann János Informatikai Kar Budapest.
Orv Hetil. 2019 Mar;160(13):509-515. doi: 10.1556/650.2019.31347.
In the treatment of non-valvular atrial fibrillation (AF) with oral anticoagulants (OAC), medical adherence is a relevant factor for stroke prevention.
To evaluate the one-year persistence of vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) in patients suffering from AF and already treated with OACs.
Information from the National Health Insurance Fund of Hungary prescriptions database on pharmacy claims between June 1, 2015 and December 31, 2015 was analysed. Authors identified patients who filled prescriptions for OACs (VKAs or DOACs) prescribed for AF who have already received OACs therapy during one year before. Apparatus of survival analysis was used, where 'survival' was the time to abandon the medication.
196 016 patients met the inclusion criteria. 181 810 patients received VKA and 14 206 patients were treated with DOACs. The one-year persistence rate in patients taking VKA was 52.9% whereas it was 66.8% in those on the DOACs. The persistence rates after 360 days were 67.5% for rivaroxaban, 63.6% for apixaban and 63.4% for dabigatran. The mean duration of persistence was 311 days for rivaroxaban, 308 days for apixaban and 284 days for dabigatran. The actual rate of discontinuation was 14% (HR = 1.14 [95% CI 1.05-1.24]), p = 0.0015) for apixaban, 15% (HR = 1.15 [95% CI 1.08-1.23], p = 0.003) for dabigatran and 62% (HR = 1.62 [95% CI 1.56-1.69], p<0.0001) for VKA compared to rivaroxaban (reference).
The authors have confirmed that the one-year persistence of DOAKs was significantly higher compared to KVA therapy in AF. The one-year persistence of rivaroxaban was more favoured than apixaban and dabigatran. Orv Hetil. 2019; 160(13): 509-515.
在使用口服抗凝剂（OAC）治疗非瓣膜性心房颤动（AF）时，药物依从性是预防中风的一个相关因素。
评估维生素K拮抗剂（VKA）和直接口服抗凝剂（DOAC）在已接受OAC治疗的AF患者中的一年持续用药情况。
分析了匈牙利国家健康保险基金处方数据库中2015年6月1日至2015年12月31日期间药房报销信息。作者确定了那些为AF开具OAC（VKA或DOAC）处方且在之前一年已接受OAC治疗的患者。采用生存分析方法，其中“生存”时间为停药时间。
196016名患者符合纳入标准。181810名患者接受VKA治疗，14206名患者接受DOAC治疗。服用VKA患者的一年持续用药率为52.9%，而服用DOAC患者的这一比例为66.8%。360天后，利伐沙班的持续用药率为67.5%，阿哌沙班为63.6%，达比加群为63.4%。利伐沙班的平均持续用药时长为311天，阿哌沙班为308天，达比加群为284天。与利伐沙班（对照）相比，阿哌沙班的实际停药率为14%（HR = 1.14 [95% CI 1.05 - 1.24]），p = 0.（此处原文有误，应为0.0）015）；达比加群为15%（HR = 1.15 [95% CI 1.08 - 1.23]，p = 0.003）；VKA为62%（HR = 1.62 [95% CI 1.56 - 1.69]，p < 0.0001）。
作者证实，在AF患者中，DOAC的一年持续用药率显著高于VKA治疗。利伐沙班的一年持续用药情况比阿哌沙班和达比加群更具优势。《匈牙利医学周报》。2019年；160(13): 509 - 515。
