Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Haematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands.
J Thromb Haemost. 2022 Feb;20(2):339-352. doi: 10.1111/jth.15592. Epub 2021 Nov 23.
Non-valvular atrial fibrillation (NVAF) patients are advised to switch from a vitamin K antagonist (VKA) to direct oral anticoagulant (DOAC) when time in therapeutic range (TTR) is low.
To examine if pre-switch TTR determines persistence patterns in NVAF patients who are switched from a VKA to DOAC.
PATIENTS/METHODS: Adult NVAF patients from three Dutch anticoagulation clinics who were newly switched from a VKA to DOAC between July 1, 2013 and September 30, 2018 were stratified by pre-switch TTR levels. DOAC prescription records were examined to determine persistence patterns according to a 100-day prescription gap. Cumulative incidences of non-persistence to DOAC were estimated using the cumulative incidence competing risk method. The association of pre-switch TTR levels with DOAC non-persistence was evaluated by Cox regression models.
A total of 3696 NVAF patients were included, of whom 690 (18.7%) had a pre-switch TTR ≤ 45%. After switching from VKA to DOAC, 14.0% (95% confidence interval [CI] 11.3-17.0%) of the patients with a pre-switch TTR ≤ 45% became non-persistent to DOAC within 1 year, while 9.8% (95% CI 8.7-11.0%) did in those with a pre-switch TTR > 45%. In a multivariable model, a pre-switch TTR ≤ 45% was associated with a higher risk of non-persistence to DOAC (adjusted hazard ratio 1.55, 95% CI 1.22-1.97). Results were similar when using other cut-off points (60% or 70%) to define a low TTR.
NVAF patients switching from VKA to DOAC due to a low pre-switch TTR saw a worse persistence pattern to DOAC after the switch compared to patients with a high pre-switch TTR.
当治疗窗时间（TTR）较低时，建议非瓣膜性心房颤动（NVAF）患者将维生素 K 拮抗剂（VKA）转换为直接口服抗凝剂（DOAC）。
检查 NVAF 患者从 VKA 转换为 DOAC 后，预先 TTR 是否决定了其持续性模式。
患者/方法：2013 年 7 月 1 日至 2018 年 9 月 30 日期间，从荷兰三个抗凝诊所新转换为 DOAC 的成年 NVAF 患者，根据预先 TTR 水平分层。根据 100 天处方间隔，检查 DOAC 处方记录以确定持续性模式。使用累积发病率竞争风险法估计 DOAC 不依从的累积发生率。通过 Cox 回归模型评估预先 TTR 水平与 DOAC 不依从的相关性。
共纳入 3696 例 NVAF 患者，其中 690 例（18.7%）转换前 TTR 水平≤45%。从 VKA 转换为 DOAC 后，转换前 TTR 水平≤45%的患者中有 14.0%（95%置信区间[CI] 11.3-17.0%）在 1 年内对 DOAC 不再持续，而转换前 TTR 水平>45%的患者中有 9.8%（95% CI 8.7-11.0%）。在多变量模型中，转换前 TTR 水平≤45%与对 DOAC 不依从的风险增加相关（调整后的危险比 1.55，95% CI 1.22-1.97）。当使用其他 TTR 水平（60%或 70%）作为低 TTR 的定义时，结果相似。
由于转换前 TTR 较低，从 VKA 转换为 DOAC 的 NVAF 患者在转换后对 DOAC 的持续性模式较差，与转换前 TTR 较高的患者相比。
