Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Department of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland.
BMJ Open. 2023 Jan 5;13(1):e065700. doi: 10.1136/bmjopen-2022-065700.
Previous observational studies have yielded conflicting results on whether medication adherence differs between patients receiving warfarin and direct oral anticoagulants (DOACs). Importantly, no study has adequately accounted for warfarin dosing being continuously modified based on INR values while dosing of DOACs is fixed. We aimed to compare non-adherence between new users of apixaban, dabigatran, rivaroxaban and warfarin in a population-based cohort.
New users of apixaban, dabigatran, rivaroxaban and warfarin from 2014 to 2019 living in the Icelandic capital area were included. Non-adherence was defined as proportion of days covered below 80%. Inverse probability weighting was used to yield balanced study groups and non-adherence was compared using logistic regression. Factors associated with non-adherence were estimated using multivariable logistic regression.
Overall, 1266 patients received apixaban, 247 dabigatran, 1566 rivaroxaban and 768 warfarin. The proportion of patients with non-adherence ranged from 10.5% to 16.7%. Dabigatran was associated with significantly higher odds of non-adherence compared with apixaban (OR 1.57, 95% CI 1.21 to 2.04, p<0.001), rivaroxaban (OR 1.45, 95% CI 1.12 to 1.89, p=0.005) and warfarin (OR 1.63, 95% CI 1.23 to 2.15, p<0.001). The odds of non-adherence were similar for apixaban, rivaroxaban and warfarin. Apart from the type of oral anticoagulants (OACs) used, female sex, hypertension, history of cerebrovascular accident and concomitant statin use were all independently associated with lower odds of non-adherence.
Dabigatran was associated with higher odds of non-adherence compared with other OACs. Non-adherence was similar between apixaban, rivaroxaban and warfarin users. Female sex and higher comorbidity were associated with better medication adherence.
先前的观察性研究结果显示，接受华法林和直接口服抗凝剂（DOACs）治疗的患者之间的药物依从性存在差异，但结果并不一致。重要的是，没有研究充分考虑到华法林的剂量是根据 INR 值持续调整的，而 DOACs 的剂量是固定的。我们旨在比较新型抗凝药阿哌沙班、达比加群、利伐沙班和华法林在基于人群的队列中新使用者之间的不依从性。
纳入 2014 年至 2019 年居住在冰岛首都地区的新型抗凝药阿哌沙班、达比加群、利伐沙班和华法林使用者。不依从性定义为覆盖天数比例低于 80%。采用逆概率加权法生成均衡的研究组，并使用逻辑回归比较不依从性。使用多变量逻辑回归估计与不依从性相关的因素。
总体而言，1266 例患者接受阿哌沙班治疗，247 例患者接受达比加群治疗，1566 例患者接受利伐沙班治疗，768 例患者接受华法林治疗。不依从性患者的比例为 10.5%至 16.7%。与阿哌沙班相比，达比加群的不依从性显著更高（OR 1.57，95%CI 1.21 至 2.04，p<0.001）、利伐沙班（OR 1.45，95%CI 1.12 至 1.89，p=0.005）和华法林（OR 1.63，95%CI 1.23 至 2.15，p<0.001）。阿哌沙班、利伐沙班和华法林的不依从性概率相似。除使用的口服抗凝药物（OACs）类型外，女性、高血压、卒中和同时使用他汀类药物与较低的不依从性相关。
与其他 OACs 相比，达比加群的不依从性更高。阿哌沙班、利伐沙班和华法林使用者的不依从性相似。女性和更高的合并症与更好的药物依从性相关。
