Service de cardiologie, hôpital européen Georges-Pompidou, Paris, France.
Hôpital Bichat, AP-HP, Paris, France; Université de Paris, Paris, France; Inserm U-1148, Paris, France.
Arch Cardiovasc Dis. 2022 Nov;115(11):571-577. doi: 10.1016/j.acvd.2022.06.006. Epub 2022 Sep 29.
Direct oral anticoagulants (DOACs) were developed as an alternative to vitamin K antagonists (VKAs) and are commonly used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Unlike VKAs, DOACs do not require Internal Normalized Ratio (INR) monitoring, but regular intake is as important for effective anticoagulation.
This study examined treatment persistence among patients receiving oral anticoagulants (OACs) for NVAF.
Within the French healthcare claims database (SNDS), we assessed and compared the rates of non-persistence (≥ 30-day treatment gap) among patients with NVAF initiating an OAC between January 2014 and December 2016. The time-to-event of non-persistence was computed and plotted using a cumulative incidence function accounting for the competing risk of mortality. After adjusting on confounding factors, the risk for non-persistence was compared between apixaban and each other OACs using a Cox proportional hazard model, or Fine and Gray models.
In a cohort of 321,501 OAC-naive patients with NVAF, the cumulative incidence of non-persistence at 12 months considering competing risk was 44.3%, 31.0%, 41.3% and 46.8% for VKAs, apixaban, rivaroxaban and dabigatran, respectively. Median therapy duration before non-persistence ranged between 70 and 121 days. Non-persistence was lower with apixaban compared with VKAs (HR=0.63, 95%CI=[0.62-0.64]), rivaroxaban (HR=0.71, 95%CI=[0.70-0.73]), and dabigatran (HR=0.60, 95%CI=[0.59-0.62]).
In this nationwide observational study, non-persistence rates of oral anticoagulant treatment were high in patients treated for NVAF. Apixaban-treated patients seem to experience lowest discontinuation rates 12 months after treatment initiation compared to patients treated with any other OAC.
直接口服抗凝剂（DOACs）作为维生素 K 拮抗剂（VKAs）的替代品开发，常用于预防非瓣膜性心房颤动（NVAF）患者的中风。与 VKAs 不同，DOACs 不需要国际标准化比值（INR）监测，但为了有效抗凝，定期服用同样重要。
本研究评估了 NVAF 患者接受口服抗凝剂（OAC）治疗的治疗持续性。
在法国医疗保健索赔数据库（SNDS）中，我们评估并比较了 2014 年 1 月至 2016 年 12 月期间开始使用 OAC 的 NVAF 患者的非持续性（≥30 天治疗空白）率。使用考虑到死亡率竞争风险的累积发生率函数计算并绘制非持续性的时间事件。在调整混杂因素后，使用 Cox 比例风险模型或 Fine 和 Gray 模型比较了阿哌沙班与其他 OAC 之间的非持续性风险。
在一组 321501 名 OAC 初治的 NVAF 患者中，考虑到竞争风险，12 个月时非持续性的累积发生率分别为 VKAs、阿哌沙班、利伐沙班和达比加群的 44.3%、31.0%、41.3%和 46.8%。非持续性之前的中位治疗持续时间在 70 至 121 天之间。与 VKAs 相比，阿哌沙班的非持续性发生率较低（HR=0.63，95%CI=[0.62-0.64]），利伐沙班（HR=0.71，95%CI=[0.70-0.73]）和达比加群（HR=0.60，95%CI=[0.59-0.62]）。
在这项全国性观察性研究中，NVAF 患者接受口服抗凝剂治疗的非持续性率很高。与接受任何其他 OAC 治疗的患者相比，接受阿哌沙班治疗的患者在治疗开始后 12 个月似乎经历的停药率最低。
