Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea.
Korean J Intern Med. 2020 Jan;35(1):99-108. doi: 10.3904/kjim.2017.415. Epub 2019 Apr 25.
BACKGROUND/AIMS: Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are more convenient to administer than warfarin, their lack of monitoring may predispose patients to nonpersistence. We compared the persistence of NOAC and VKA treatment for AF in real-world practice.
In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 7,013 patients with nonvalvular AF (mean age 67.2 ± 10.9 years, women 36.4%) were consecutively enrolled between June 2016 and June 2017 from 10 tertiary hospitals in Korea. This study included 3,381 patients who started OAC 30 days before enrollment (maintenance group) and 572 patients who newly started OAC (new-starter group). The persistence rate of OAC was evaluated.
In the maintenance group, persistence to OAC declined during 6 months, to 88.3% for VKA and 95.5% for NOAC (p < 0.0001). However, the persistence rate was not different among NOACs. In the new-starter group, persistence to OAC declined during 6 months, to 78.9% for VKA and 92.1% for NOAC (p < 0.0001). The persistence rate was lower for rivaroxaban (83.7%) than apixaban (94.6%) and edoxaban (94.1%, p < 0.001). In the new-starter group, diabetes, valve disease, and cancer were related to nonpersistence of OAC.
Nonpersistence was significantly lower with NOAC than VKA in both the maintenance and new-starter groups. In only the new-starter group, apixaban or edoxaban showed higher persistence rates than rivaroxaban.
背景/目的：为了降低房颤（AF）患者的中风风险，人们一直致力于提高医生对口服抗凝剂（OAC）指南的依从性；然而，维生素 K 拮抗剂（VKA）的早期停药率高是一个限制因素。虽然新型口服抗凝剂（NOACs）比华法林使用起来更方便，但由于缺乏监测，可能会导致患者无法持续用药。我们比较了在真实世界的实践中，NOAC 和 VKA 治疗 AF 的持续性。
在一项前瞻性观察性登记研究（比较药物治疗症状控制和预防房颤并发症的研究[CODE-AF 登记研究]）中，2016 年 6 月至 2017 年 6 月期间，韩国 10 家三级医院连续纳入了 7013 例非瓣膜性房颤（平均年龄 67.2±10.9 岁，女性 36.4%）患者。本研究纳入了 3381 例 OAC 治疗 30 天前开始（维持组）和 572 例新开始 OAC（新启动组）的患者。评估 OAC 的持续率。
在维持组中，OAC 的持续率在 6 个月内下降，VKA 为 88.3%，NOAC 为 95.5%（p<0.0001）。然而，NOAC 之间的持续率没有差异。在新启动组中，OAC 的持续率在 6 个月内下降，VKA 为 78.9%，NOAC 为 92.1%（p<0.0001）。利伐沙班（83.7%）的持续率低于阿哌沙班（94.6%）和依度沙班（94.1%，p<0.001）。在新启动组中，糖尿病、瓣膜病和癌症与 OAC 的不持续有关。
在维持组和新启动组中，NOAC 的不持续性明显低于 VKA。仅在新启动组中，阿哌沙班或依度沙班的持续率高于利伐沙班。
