Abstract 13898: Atrial Fibrillation And Persistence With Anticoagulant Treatment
Introduction: Treatment with oral anticoagugulants (OACs) effectively reduces the risk for ischemic stroke, but undertreatment with warfarin has since long been a problem. Three non-vitamin K antagonist oral anticoagulants (NOACs) now provide alternatives to warfarin. The main aim of this study was to assess the overall persistence with OACs and to compare the persistence with different types of OACs in patients with atrial fibrillation and a risk score indicating anticoagulant treatment.
Methods: All individuals with non-valvular atrial fibrillation and CHADSVASc scores of 2-9 who had a first claim of either warfarin (n=9916 ), dabigatran (n= 2678), rivaroxaban (n= 2062), or apixaban (n= 1340) from April 2011 until December 2014 were identified in the administrative health data register (VAL) of the Stockholm region (2.1 million inhabitants). VAL contains anonymized data regarding diagnoses, age, sex, prescription claims, hospitalizations and other healthcare consultations (including primary care), migration and death. Multivariate analysis was performed adjusting for age, sex, prior anticoagulant treatment, prescriber category, and the total numbers of drugs claimed by the patients.
Results: The overall persistence with any OAC was 88% (CI 0.87-0.89 ) at one year and 83 % (CI 0.82-0.84) at two years. After one year the crude persistence was 85% with warfarin (CI 0.84-0.86), 86% with apixaban (CI 0.82-0.90), 74% with dabigatran (CI 0.72-0.76), and 77% with rivaroxaban (CI 0.75-0.80). Multivariate analysis confirmed statistically significant differences, with warfarin and apixaban having higher persistence than dabigatran or rivaroxaban .
Conclusions: The long-term overall persistence to anticoagulant treatment was high in patients with non-valvular atrial fibrillation in the Stockholm region. The results indicate better persistence with warfarin and apixaban than with dabigatran or rivaroxaban in actual care.
Author Disclosures: T. Forslund: None. B. Wettermark: None. P. Hjemdahl: None.
- © 2015 by American Heart Association, Inc.