Drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the Dresden non-interventional oral anticoagulation registry

AIMS: Worldwide, rivaroxaban is increasingly used for stroke prevention in atrial fibrillation (SPAF) but little is known about the rates of or reasons for rivaroxaban discontinuations in daily care. Using data from a prospective, non-interventional oral anticoagulation (NOAC) registry, we analysed...

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Autores principales: Beyer-Westendorf, Jan, Förster, Kati, Ebertz, Franziska, Gelbricht, Vera, Schreier, Thomas, Göbelt, Maria, Michalski, Franziska, Endig, Heike, Sahin, Kurtulus, Tittl, Luise, Weiss, Norbert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2015
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381834/
https://www.ncbi.nlm.nih.gov/pubmed/25694537
http://dx.doi.org/10.1093/europace/euu319
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author Beyer-Westendorf, Jan
Förster, Kati
Ebertz, Franziska
Gelbricht, Vera
Schreier, Thomas
Göbelt, Maria
Michalski, Franziska
Endig, Heike
Sahin, Kurtulus
Tittl, Luise
Weiss, Norbert
author_facet Beyer-Westendorf, Jan
Förster, Kati
Ebertz, Franziska
Gelbricht, Vera
Schreier, Thomas
Göbelt, Maria
Michalski, Franziska
Endig, Heike
Sahin, Kurtulus
Tittl, Luise
Weiss, Norbert
author_sort Beyer-Westendorf, Jan
collection PubMed
description AIMS: Worldwide, rivaroxaban is increasingly used for stroke prevention in atrial fibrillation (SPAF) but little is known about the rates of or reasons for rivaroxaban discontinuations in daily care. Using data from a prospective, non-interventional oral anticoagulation (NOAC) registry, we analysed rivaroxaban treatment persistence. METHODS AND RESULTS: Persistence with rivaroxaban in SPAF was assessed in an ongoing, prospective, non-interventional registry of >2600 NOAC patients from daily care using the Kaplan–Meier time-to-first-event analysis. Reasons for and management of rivaroxaban discontinuation were assessed. Potential baseline risk factors for treatment discontinuation were evaluated using Cox regression analysis. Between October 2011 and April 2014, 1204 rivaroxaban SPAF patients were enrolled [39.3% switched from vitamin K antagonists (VKAs) and 60.7% newly treated patients]. Of these, 223 patients (18.5%) stopped rivaroxaban during follow-up (median 544 days), which translates into a discontinuation rate of 13.6 (95% CI 11.8–15.4) per 100 patient-years. Most common reasons for treatment discontinuations were bleeding complications (30% of all discontinuations), followed by other side-effects (24.2%) and diagnosis of stable sinus rhythm (9.9%). A history of chronic heart failure (HR 1.43; 95% CI 1.09–1.87; P = 0.009) or diabetes (HR 1.39; 95% CI 1.06–1.82; P = 0.018) were the only statistically significant baseline risk factors for rivaroxaban discontinuation. After discontinuation of rivaroxaban, patients received antiplatelet therapy (31.8%), VKA (24.2%), another NOAC (18.4%), heparin (9.9%), or nothing (15.7%). CONCLUSION: Our data indicate that overall persistence with rivaroxaban therapy is high, with a discontinuation rate of ∼15% in the first year of treatment and few additional discontinuations thereafter.
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spelling pubmed-43818342015-04-03 Drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the Dresden non-interventional oral anticoagulation registry Beyer-Westendorf, Jan Förster, Kati Ebertz, Franziska Gelbricht, Vera Schreier, Thomas Göbelt, Maria Michalski, Franziska Endig, Heike Sahin, Kurtulus Tittl, Luise Weiss, Norbert Europace Clinical Research AIMS: Worldwide, rivaroxaban is increasingly used for stroke prevention in atrial fibrillation (SPAF) but little is known about the rates of or reasons for rivaroxaban discontinuations in daily care. Using data from a prospective, non-interventional oral anticoagulation (NOAC) registry, we analysed rivaroxaban treatment persistence. METHODS AND RESULTS: Persistence with rivaroxaban in SPAF was assessed in an ongoing, prospective, non-interventional registry of >2600 NOAC patients from daily care using the Kaplan–Meier time-to-first-event analysis. Reasons for and management of rivaroxaban discontinuation were assessed. Potential baseline risk factors for treatment discontinuation were evaluated using Cox regression analysis. Between October 2011 and April 2014, 1204 rivaroxaban SPAF patients were enrolled [39.3% switched from vitamin K antagonists (VKAs) and 60.7% newly treated patients]. Of these, 223 patients (18.5%) stopped rivaroxaban during follow-up (median 544 days), which translates into a discontinuation rate of 13.6 (95% CI 11.8–15.4) per 100 patient-years. Most common reasons for treatment discontinuations were bleeding complications (30% of all discontinuations), followed by other side-effects (24.2%) and diagnosis of stable sinus rhythm (9.9%). A history of chronic heart failure (HR 1.43; 95% CI 1.09–1.87; P = 0.009) or diabetes (HR 1.39; 95% CI 1.06–1.82; P = 0.018) were the only statistically significant baseline risk factors for rivaroxaban discontinuation. After discontinuation of rivaroxaban, patients received antiplatelet therapy (31.8%), VKA (24.2%), another NOAC (18.4%), heparin (9.9%), or nothing (15.7%). CONCLUSION: Our data indicate that overall persistence with rivaroxaban therapy is high, with a discontinuation rate of ∼15% in the first year of treatment and few additional discontinuations thereafter. Oxford University Press 2015-04 2015-02-18 /pmc/articles/PMC4381834/ /pubmed/25694537 http://dx.doi.org/10.1093/europace/euu319 Text en © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research
Beyer-Westendorf, Jan
Förster, Kati
Ebertz, Franziska
Gelbricht, Vera
Schreier, Thomas
Göbelt, Maria
Michalski, Franziska
Endig, Heike
Sahin, Kurtulus
Tittl, Luise
Weiss, Norbert
Drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the Dresden non-interventional oral anticoagulation registry
title Drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the Dresden non-interventional oral anticoagulation registry
title_full Drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the Dresden non-interventional oral anticoagulation registry
title_fullStr Drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the Dresden non-interventional oral anticoagulation registry
title_full_unstemmed Drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the Dresden non-interventional oral anticoagulation registry
title_short Drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the Dresden non-interventional oral anticoagulation registry
title_sort drug persistence with rivaroxaban therapy in atrial fibrillation patients—results from the dresden non-interventional oral anticoagulation registry
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381834/
https://www.ncbi.nlm.nih.gov/pubmed/25694537
http://dx.doi.org/10.1093/europace/euu319
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