Abstract 17731: Persistence With Non-vitamin K Oral Anticoagulants And Vitamin K Antagonists Treatment: A Nationwide Study Of Danish Patients With Non-Valvular Atrial Fibrillation
Introduction: Treatment with oral anticoagulation (OAC) in patients with atrial fibrillation (AF) has changed substantially since approval of Non-vitamin K oral anticoagulants (NOAC), but little is known on everyday use. The purpose of this study was to describe use and persistence with NOACs and vitamin K antagonists (VKA) in patients with AF.
Methods: By linkage of Danish nationwide registers, we identified patients with AF who claimed a prescription of a NOAC (dabigatran, rivaroxaban, and apixaban), or VKA. Prescriptions were used to calculate Proportions of Days Covered (PDC), refill gaps, and switch in treatment. Odds Ratios (OR), Hazard Rate Ratios (HRR) and 95% Confidence Intervals (CI) were calculated and adjusted for age, gender, comorbidities, and concomitant drugs.
Results: Between 2011 and 2014 a total of 46 675 patients with AF claimed a prescription of an OAC: 57.3% used VKA, 29.8% dabigatran, 8.5% rivaroxaban, and 4.4% apixaban. During the first 180 days PDC > 80% was highest among users of rivaroxaban, OR (rivaroxaban as ref.): apixaban 0.79 (CI 0.69-0.92), dabigatran 0.72 (CI 0.66-0.80), and VKA 0.76 (CI 0.69-0.83). Correspondingly users of rivaroxaban had the lowest rate of refill gaps between 7-89 days HRR (rivaroxaban as ref.): apixaban 1.52 (CI 1.36- 1.69), dabigatran 1.72 (CI 1.60- 1.85), and VKA 2.36 (CI 2.20- 2.52). Refill gaps >89 days occurred in 11.5% of VKA patients, with substantially lower rates for patients treated with NOAC (6.1% dabigatran, 3.4% rivaroxaban, and 2.6% apixaban). Incidence of switch between OAC was highest in users of dabigatran (21.0%) and lowest in users of apixaban (8.6%). Adjusted results are shown i Figures.
Conclusion: In AF patients treated with OAC 42.7 % patients were treated with NOAC. Refill gaps occurred most often in users VKA, whereas switch between OAC was highest among users of dabigatran and lowest in users of apixaban. PDC > 80%, and periods without refill gaps were highest among users of rivaroxaban.
Author Disclosures: R. Sørensen: Research Grant; Modest; Unrestricted research grant. J.L. Pallisgaard: Research Grant; Modest; Unrestricted research grant. B.J. Nielsen: Research Grant; Modest; Unrestricted research grant. K. Bowrin: Employment; Significant; Full time employment. C. Torp-Pedersen: Research Grant; Modest; Unrestricted research grant.
- © 2016 by American Heart Association, Inc.