The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA.
Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, CA, USA.
J Interv Card Electrophysiol. 2024 Jun;67(4):709-718. doi: 10.1007/s10840-023-01585-x. Epub 2023 Aug 9.
Real-world data have suggested inconsistent adherence to oral anticoagulation for thromboembolic event (TE) prevention in patients with Non valvular atrial fibrillation (NVAF), yet it remains unclear if event risk is elevated during gaps of non-adherence.
To compare difference in outcomes between direct oral anticoagulant (DOAC) and warfarin based on adherence to the therapy in patients with NVAF.
Using the MarketScan claims data, patients receiving prescription of warfarin or a DOAC for NVAF from January 2015 to June 2016 were included. Outcomes included hospitalization for TE (ischemic stroke or systemic embolism), hemorrhagic stroke, stroke of any kind, and major bleeding. Event rates were reported for warfarin and DOACs at a higher-adherence proportion of days covered (PDC > 80%) and lower-adherence (PDC 40-80%).
The cohort included 83,168 patients prescribed warfarin (51% [n = 42,639]) or DOAC (49% [n = 40,529]). Lower adherence occurred in 36% (n = 15,330) of patients prescribed warfarin and 26% (n = 10,956) prescribed DOAC. As compared to higher-adherence warfarin after multivariable adjustment, the risk of TE was highest in lower-adherence DOAC (HR 1.26; 95% CI, 1.14-1.33), and lowest in higher-adherence DOAC (HR, 0.93; 95% CI, 0.88-0.99). There was a significantly higher risk of hemorrhagic stroke and stroke of any kind in the lower-adherence groups. Major bleeding was more common with lower-adherence DOAC (HR, 1.43, 95% CI, 1.35-1.52) and lower-adherence warfarin (HR, 1.32, 95% CI, 1.26-1.39).
In this large real-world study, low adherence DOAC was associated with higher risk of TE events as compared to high and low adherence warfarin.
真实世界的数据表明，在非瓣膜性心房颤动（NVAF）患者中，血栓栓塞事件（TE）预防的口服抗凝治疗依从性不一致，但尚不清楚在不依从期间是否会增加事件风险。
比较 NVAF 患者基于对治疗的依从性，直接口服抗凝剂（DOAC）与华法林之间的结果差异。
使用 MarketScan 索赔数据，纳入 2015 年 1 月至 2016 年 6 月期间接受 NVAF 华法林或 DOAC 处方的患者。结果包括 TE（缺血性中风或系统性栓塞）、脑出血、任何类型的中风和大出血住院治疗。报告了华法林和 DOAC 的事件发生率，在较高的覆盖天数比例（PDC > 80%）和较低的依从性（PDC 40-80%）下。
该队列纳入了 83168 名接受华法林（51%[n=42639]）或 DOAC（49%[n=40529]）处方的患者。36%（n=15330）的华法林和 26%（n=10956）的 DOAC 患者依从性较低。经多变量调整后，与高依从性华法林相比，低依从性 DOAC 的 TE 风险最高（HR 1.26；95%CI，1.14-1.33），高依从性 DOAC 的风险最低（HR，0.93；95%CI，0.88-0.99）。低依从性组脑出血和任何类型中风的风险显著增加。低依从性 DOAC（HR，1.43，95%CI，1.35-1.52）和低依从性华法林（HR，1.32，95%CI，1.26-1.39）的大出血更为常见。
在这项大型真实世界研究中，与高和低依从性华法林相比，低依从性 DOAC 与 TE 事件风险增加相关。
