ArticleAmerican journal of cardiovascular drugs : drugs, devices, and other interventions2022
Non-persistence to Oral Anticoagulation Treatment in Patients with Non-valvular Atrial Fibrillation in the USA.
Article in American journal of cardiovascular drugs : drugs, devices, and other interventions, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Correct dosing, adherence and persistence of DOACs in atrial fibrillation and chronic kidney disease: a systematic review and meta-analysis.Open heart · 2023Pooled it
- Article
- Geographic Variation in Persistence of Oral Anticoagulant Treatment Among Patients with Non-Valvular Atrial Fibrillation in the United States.Journal of clinical medicine · 2025Article
- Evaluation of the treatment patterns among commercially insured patients with nonvalvular atrial fibrillation prescribed an oral anticoagulant by race/ethnicity.Journal of comparative effectiveness research · 2025Article
- Establishing a Validation Framework of Treatment Discontinuation in Claims Data Using Natural Language Processing and Electronic Health Records.Clinical pharmacology and therapeutics · 2025Article
- Non-Medical Switching or Discontinuation Patterns among Patients with Non-Valvular Atrial Fibrillation Treated with Direct Oral Anticoagulants in the United States: A Claims-Based Analysis.Journal of market access & health policy · 2024Article
- Evaluating the effect of inequalities in oral anti-coagulant prescribing on outcomes in people with atrial fibrillation.European heart journal open · 2024Article
- Article
- Non‑persistence to Oral Anticoagulation Therapy in Elderly Patients with Non‑valvular Atrial Fibrillation.Patient preference and adherence · 2023Article
- Trends in Use of Oral Anticoagulants in Older Adults With Newly Diagnosed Atrial Fibrillation, 2010-2020.JAMA network open · 2022Article
- External validation and comparison of CHAJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2022Article
- Oral Anticoagulant Discontinuation and Its Predictors in Patients with Atrial Fibrillation.Journal of clinical medicine · 2022Article
- Decision of Anticoagulation in Nonvalvular Atrial Fibrillation in the Real World in the Non-Antivitamin K Anticoagulants Era.Healthcare (Basel, Switzerland) · 2022Article
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Authors and funding
10 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStudies have shown that patients with non-valvular atrial fibrillation (NVAF) who discontinue oral anticoagulants (OACs) are at higher risk of complications such as stroke.
objectiveThis analysis compared the risk of non-persistence with OACs among patients with NVAF.
methodsAdult patients with NVAF who initiated apixaban, dabigatran, rivaroxaban, or warfarin were identified using 01JAN2013-30JUN2019 data from Centers for Medicare and Medicaid Services and four US commercial claims databases. Non-persistence was defined as discontinuation (no evidence of index OAC use for ≥ 60 days from the last days' supply) or switch to another OAC. Kaplan-Meier curves were generated to illustrate time to non-persistence along with cumulative incidences of non-persistence. Baseline and time-varying covariates were evaluated, and adjusted Cox proportional hazards models were used to evaluate non-persistence risk.
resultsIn total, 363,823 patients receiving apixaban, 57,121 receiving dabigatran, 282,831 receiving rivaroxaban, and 317,337 receiving warfarin were included. Of these, 47-72% discontinued/switched OAC therapy within an average 9-month follow-up. Apixaban was associated with a lower risk of non-persistence than were dabigatran (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.61-0.62), rivaroxaban (HR 0.76; 95% CI 0.75-0.76), and warfarin (HR 0.74; 95% CI 0.74-0.75). Dabigatran was associated with a higher risk of non-persistence than were warfarin (HR 1.21; 95% CI 1.19-1.22) and rivaroxaban (HR 1.23; 95% CI 1.22-1.25), and rivaroxaban was associated with a lower risk of non-persistence than was warfarin (HR 0.98; 95% CI 0.97-0.98). Clinical events (stroke/systemic embolism and major bleeding [MB]) during follow-up were predictors of non-persistence (stroke HR 1.57; 95% CI 1.53-1.61; MB HR 2.96; 95% CI 2.92-3.00).
conclusionIn over one million patients with NVAF, our results suggest differences in anticoagulation treatment persistence across OAC agents, even after accounting for clinical events after OAC initiation. It is important for clinicians and patients to take these differences into consideration, especially as non-persistence to OAC therapy is associated with thromboembolic complications.
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