Discontinuation rates of warfarin versus direct acting oral anticoagulants in US clinical practice: Results from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II) - 16/08/20
, Sunghee Kim, PhD a, Rosalia Blanco a, Laine Thomas, PhD a, Jack Ansell, MD b, Gregg C. Fonarow, MD c, Bernard J. Gersh, MB, ChB, DPhil d, Alan S. Go, MD e, Peter R. Kowey, MD f, Kenneth W. Mahaffey, MD g, Elaine M. Hylek, MD, MPH h, Eric D. Peterson, MD, MPH a, Jonathan P. Piccini, Sr., MD, MHS aon behalf of the
Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II
Background |
While oral anticoagulation is a cornerstone of stroke prevention therapy in atrial fibrillation (AF), few studies have evaluated comparative discontinuation rates in clinical practice. The objective of this study is to evaluate discontinuation rates among patients on warfarin and direct oral anticoagulants (DOACs) in clinical practice.
Methods |
The ORBIT-AF II Registry enrolled 10,005 total AF patients with a CHA2DS2VASc score of ≥2 on warfarin or DOACs from 235 clinical practices across the US from February 13, 2013 and July 12, 2017. Descriptive statistics and multivariable Cox regression modeling were used to describe baseline characteristics and predictors of discontinuation. Unadjusted and adjusted discontinuation rates and 95% confidence intervals (CI) were calculated using Cox proportional hazards models and propensity score adjustment, respectively.
Results |
At baseline, 16.4% (N = 1642/10,005) were treated with warfarin, 83.6% (N = 8363/10,005) with DOACs and 1498/10,005 patients (15.0%) discontinued therapy [warfarin = 236/1642 (14.4%) vs DOACs = 1262/8363 (15.1%)]. At 6 and 12 months respectively, among 7049 patients with a new diagnosis of AF within 6 months, adjusted discontinuation rates for warfarin versus DOACs were as follows: [6 months: 7.9%, 95%CI (6.8%-9.0%) vs 9.6% (8.4%-10.7%), P = .16]; [12 months: 12.7% (11.0%-14.3%) vs 15.3% (13.6%-16.9%), P = .02)]. Patients who discontinued therapy with warfarin or DOACs had higher risk of adverse clinical outcomes including: all-cause mortality and cardiovascular death (CV) than those who continued treatment.
Conclusion |
In a community based AF cohort, adjusted rates of discontinuation at 12-months were higher in DOAC-treated versus VKA-treated patients. Discontinuation of oral anticoagulation was associated with increased absolute risk of all-cause mortality and CV death.
Clinical Trial Registration |
URL:clinicaltrials.gov. Unique Identifier: NCT01701817
Le texte complet de cet article est disponible en PDF.Abbreviations : AF, ATRIA, CVA, DOACs, INR, OAC, TIA, VKA
Plan
| T. Jared Bunch, MD served as guest editor for this article. |
Vol 226
P. 85-93 - août 2020 Retour au numéro
Article précédent
- Population-level surveillance of congenital heart defects among adolescents and adults in Colorado: Implications of record linkage
- Tessa L. Crume, Lindsey M. Duca, Toan Ong, Emily Kraus, Ken Scott, Amber Khanna, David Kao, Christopher M. Rausch, Lisa McKenzie, Matthew F. Daley, Suzanne Coleman, Michael G. Kahn, Everett Costa, Arthur J. Davidson
- Predictors of Fabry disease in patients with hypertrophic cardiomyopathy: How to guide the diagnostic strategy?
- Olga Azevedo, Nuno Marques, Liliana Reis, Inês Cruz, Nuno Craveiro, Hugo Antunes, Carolina Lourenço, Renata Gomes, Rui Azevedo Guerreiro, Ricardo Faria, Fernando Sá, Rui Lima, Paulo Gaspar, Rui Faria, Gabriel Miltenberger-Miltenyi, Nuno Sousa, Damião Cunha, On behalf of the group of investigators
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?