Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Abstract Background In contrast to vitamin K antagonists (VKA), direct oral anticoagulants (DOAC's) are not strictly monitored and dose titrated by anticoagulation clinics in the Netherlands. This may affect drug persistence of atrial fibrillation (AF) patients, whom often require lifelong trea...

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Autores principales:	Gilda Denise Zielinski, Nienke vanRein, Martina Teichert, Frederikus A. Klok, Frits R. Rosendaal, Felix J. M. van derMeer, Menno V. Huisman, Suzanne C. Cannegieter, Willem M. Lijfering
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2020
Materias:	atrial fibrillation direct oral anticoagulants oral anticoagulants Persistence vitamin K antagonist Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/1d1f8cadf9954cbc8c400b71defeab7b
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spelling	oai:doaj.org-article:1d1f8cadf9954cbc8c400b71defeab7b2021-11-15T06:10:44ZPersistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study2475-037910.1002/rth2.12261https://doaj.org/article/1d1f8cadf9954cbc8c400b71defeab7b2020-01-01T00:00:00Zhttps://doi.org/10.1002/rth2.12261https://doaj.org/toc/2475-0379Abstract Background In contrast to vitamin K antagonists (VKA), direct oral anticoagulants (DOAC's) are not strictly monitored and dose titrated by anticoagulation clinics in the Netherlands. This may affect drug persistence of atrial fibrillation (AF) patients, whom often require lifelong treatment. Objectives To assess persistence of DOACs and of VKAs in patients with AF. Methods Dispensing data from the Dutch Foundation of Pharmaceutical Statistics were used to monitor persistence of AF patients to DOAC from 1 January 2012‐1 April 2016. In addition, we estimated the persistence of AF patients to VKA between 1 January 2004 and 1 January 2012 in data from the Anticoagulation Clinic Leiden. Non‐persistence was defined as the cumulative incidence of patients who completely stopped DOAC, switched to another oral anticoagulant or stopped their VKA. Results DOAC users (n = 77 333) were younger than VKA users (n = 10 079; 70 vs 73 years). Non‐Persistence to DOAC (ie stopping with any oral anticoagulant) was 34% at 1 and 64% at 4 years, compared to 22% at one and 36% at 4 years for VKA. Approximately a Twenty‐five percent of those who had stopped their initial DOAC switched to another anticoagulant (VKA or another DOAC). Multivariable analyses revealed that young age, female sex, no concomitant drug use and non‐adherence were predictors for non‐persistence of DOAC. Conclusions Persistence to DOAC was low and in line with other observational studies, and higher for VKA. Our results show a clear correlation between age <60 years and worse persistence, as well as with female and non‐adherence to DOAC.Gilda Denise ZielinskiNienke vanReinMartina TeichertFrederikus A. KlokFrits R. RosendaalFelix J. M. van derMeerMenno V. HuismanSuzanne C. CannegieterWillem M. LijferingWileyarticleatrial fibrillationdirect oral anticoagulantsoral anticoagulantsPersistencevitamin K antagonistDiseases of the blood and blood-forming organsRC633-647.5ENResearch and Practice in Thrombosis and Haemostasis, Vol 4, Iss 1, Pp 141-153 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation direct oral anticoagulants oral anticoagulants Persistence vitamin K antagonist Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	atrial fibrillation direct oral anticoagulants oral anticoagulants Persistence vitamin K antagonist Diseases of the blood and blood-forming organs RC633-647.5 Gilda Denise Zielinski Nienke vanRein Martina Teichert Frederikus A. Klok Frits R. Rosendaal Felix J. M. van derMeer Menno V. Huisman Suzanne C. Cannegieter Willem M. Lijfering Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
description	Abstract Background In contrast to vitamin K antagonists (VKA), direct oral anticoagulants (DOAC's) are not strictly monitored and dose titrated by anticoagulation clinics in the Netherlands. This may affect drug persistence of atrial fibrillation (AF) patients, whom often require lifelong treatment. Objectives To assess persistence of DOACs and of VKAs in patients with AF. Methods Dispensing data from the Dutch Foundation of Pharmaceutical Statistics were used to monitor persistence of AF patients to DOAC from 1 January 2012‐1 April 2016. In addition, we estimated the persistence of AF patients to VKA between 1 January 2004 and 1 January 2012 in data from the Anticoagulation Clinic Leiden. Non‐persistence was defined as the cumulative incidence of patients who completely stopped DOAC, switched to another oral anticoagulant or stopped their VKA. Results DOAC users (n = 77 333) were younger than VKA users (n = 10 079; 70 vs 73 years). Non‐Persistence to DOAC (ie stopping with any oral anticoagulant) was 34% at 1 and 64% at 4 years, compared to 22% at one and 36% at 4 years for VKA. Approximately a Twenty‐five percent of those who had stopped their initial DOAC switched to another anticoagulant (VKA or another DOAC). Multivariable analyses revealed that young age, female sex, no concomitant drug use and non‐adherence were predictors for non‐persistence of DOAC. Conclusions Persistence to DOAC was low and in line with other observational studies, and higher for VKA. Our results show a clear correlation between age <60 years and worse persistence, as well as with female and non‐adherence to DOAC.
format	article
author	Gilda Denise Zielinski Nienke vanRein Martina Teichert Frederikus A. Klok Frits R. Rosendaal Felix J. M. van derMeer Menno V. Huisman Suzanne C. Cannegieter Willem M. Lijfering
author_facet	Gilda Denise Zielinski Nienke vanRein Martina Teichert Frederikus A. Klok Frits R. Rosendaal Felix J. M. van derMeer Menno V. Huisman Suzanne C. Cannegieter Willem M. Lijfering
author_sort	Gilda Denise Zielinski
title	Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_short	Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_full	Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_fullStr	Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_full_unstemmed	Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_sort	persistence of oral anticoagulant treatment for atrial fibrillation in the netherlands: a surveillance study
publisher	Wiley
publishDate	2020
url	https://doaj.org/article/1d1f8cadf9954cbc8c400b71defeab7b
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Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

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