心房颤动患者口服抗凝药的依从性和持续性：一项比利时全国队列研究。

Adherence and persistence to oral anticoagulants in patients with atrial fibrillation: A Belgian nationwide cohort study.

作者信息

Grymonprez Maxim, Capiau Andreas, Steurbaut Stephane, Mehuys Els, Boussery Koen, De Backer Tine L, Lahousse Lies

机构信息

Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.

Center for Pharmaceutical Research, Research Group of Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel, Jette, Belgium.

出版信息

Front Cardiovasc Med. 2022 Sep 29;9:994085. doi: 10.3389/fcvm.2022.994085. eCollection 2022.

BACKGROUND

Since non-vitamin K antagonist oral anticoagulants (NOACs) do not require coagulation monitoring, concerns of lower adherence and persistence to NOACs than vitamin K antagonists (VKAs) have been raised. Moreover, little is known on the frequency of permanent cessation and switching between anticoagulants in patients with atrial fibrillation (AF). Therefore, persistence, reinitiation, switching and adherence to oral anticoagulants (OACs) were investigated.

MATERIALS AND METHODS

AF patients with a first OAC prescription claim between 2013 and 2019 were identified in Belgian nationwide data. Persistence, reinitiation and switching were estimated using Kaplan-Meier analyses. Adherence was investigated using the proportion of days covered (PDC). Predictors for non-adherence and non-persistence were identified by multivariable logistic regression.

RESULTS

Among 277,782 AF patients, 69.6% NOAC and 37.2% VKA users were persistent after 1 year, whereas 44.3% and 18.9% after 5 years, respectively. After one year, 67.1% rivaroxaban, 68.1% dabigatran, 69.8% apixaban, and 76.9% edoxaban users were persistent. Among subjects having discontinued NOAC or VKA treatment, 75.4% and 46.1% reinitiated any OAC within 5 years, respectively. VKAs were more frequently switched to NOACs than vice versa (17.6% versus 2.5% after 1 year). After 1 year, a high PDC (≥ 90%) was observed in 87.8% apixaban, 88.6% dabigatran, 91.3% rivaroxaban, and 94.7% edoxaban users (90.2% NOAC users). Adherence and persistence were higher in older, female subjects, while lower in subjects with dementia or hyperpolypharmacy.

CONCLUSION

Adherence and persistence to NOACs were high. However, 10% of subjects were non-adherent after 1 year and one-fourth did not reinitiate anticoagulation within 5 years after NOAC discontinuation.

背景

由于非维生素K拮抗剂口服抗凝药（NOACs）无需进行凝血监测，因此有人担心与维生素K拮抗剂（VKAs）相比，NOACs的依从性和持续性较低。此外，关于心房颤动（AF）患者永久停药以及在不同抗凝药之间转换的频率，人们了解甚少。因此，我们对口服抗凝药（OACs）的持续性、重新开始用药、转换用药及依从性进行了研究。

材料与方法

在比利时全国性数据中识别出2013年至2019年间首次开具OAC处方的AF患者。使用Kaplan-Meier分析估计持续性、重新开始用药和转换用药情况。通过计算服药天数比例（PDC）来研究依从性。通过多变量逻辑回归确定不依从和持续性不佳的预测因素。

结果

在277,782例AF患者中，1年后69.6%的NOAC使用者和37.2%的VKA使用者仍持续用药，而5年后这一比例分别为44.3%和18.9%。1年后，利伐沙班使用者的持续性为67.1%，达比加群使用者为68.1%，阿哌沙班使用者为69.8%，依度沙班使用者为76.9%。在停止使用NOAC或VKA治疗的患者中，分别有75.4%和46.1%在5年内重新开始使用任何一种OAC。VKA转换为NOAC的频率高于NOAC转换为VKA（1年后分别为17.6%和2.5%）。1年后，87.8%的阿哌沙班使用者、88.6%的达比加群使用者、91.3%的利伐沙班使用者和94.7%的依度沙班使用者（90.2%的NOAC使用者）的PDC较高（≥90%）。年龄较大的女性受试者的依从性和持续性较高，而患有痴呆症或用药过多的受试者的依从性和持续性较低。