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A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF)
BACKGROUND/AIMS: Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are m...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Korean Association of Internal Medicine
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960047/ https://www.ncbi.nlm.nih.gov/pubmed/31014064 http://dx.doi.org/10.3904/kjim.2017.415 |
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author | Kim, Hyeongsoo Lee, Young Soo Kim, Tae-Hoon Cha, Myung-Jin Lee, Jung Myung Park, Junbeom Park, Jin-Kyu Kang, Ki-Woon Shim, Jaemin Uhm, Jae-Sun Park, Hyung Wook Choi, Eue-Keun Kim, Jin-Bae Kim, Changsoo Kim, Jun Joung, Boyoung |
author_facet | Kim, Hyeongsoo Lee, Young Soo Kim, Tae-Hoon Cha, Myung-Jin Lee, Jung Myung Park, Junbeom Park, Jin-Kyu Kang, Ki-Woon Shim, Jaemin Uhm, Jae-Sun Park, Hyung Wook Choi, Eue-Keun Kim, Jin-Bae Kim, Changsoo Kim, Jun Joung, Boyoung |
author_sort | Kim, Hyeongsoo |
collection | PubMed |
description | BACKGROUND/AIMS: Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are more convenient to administer than warfarin, their lack of monitoring may predispose patients to nonpersistence. We compared the persistence of NOAC and VKA treatment for AF in real-world practice. METHODS: In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 7,013 patients with nonvalvular AF (mean age 67.2 ± 10.9 years, women 36.4%) were consecutively enrolled between June 2016 and June 2017 from 10 tertiary hospitals in Korea. This study included 3,381 patients who started OAC 30 days before enrollment (maintenance group) and 572 patients who newly started OAC (new-starter group). The persistence rate of OAC was evaluated. RESULTS: In the maintenance group, persistence to OAC declined during 6 months, to 88.3% for VKA and 95.5% for NOAC (p < 0.0001). However, the persistence rate was not different among NOACs. In the new-starter group, persistence to OAC declined during 6 months, to 78.9% for VKA and 92.1% for NOAC (p < 0.0001). The persistence rate was lower for rivaroxaban (83.7%) than apixaban (94.6%) and edoxaban (94.1%, p < 0.001). In the new-starter group, diabetes, valve disease, and cancer were related to nonpersistence of OAC. CONCLUSIONS: Nonpersistence was significantly lower with NOAC than VKA in both the maintenance and new-starter groups. In only the new-starter group, apixaban or edoxaban showed higher persistence rates than rivaroxaban. |
format | Online Article Text |
id | pubmed-6960047 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | The Korean Association of Internal Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-69600472020-01-22 A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) Kim, Hyeongsoo Lee, Young Soo Kim, Tae-Hoon Cha, Myung-Jin Lee, Jung Myung Park, Junbeom Park, Jin-Kyu Kang, Ki-Woon Shim, Jaemin Uhm, Jae-Sun Park, Hyung Wook Choi, Eue-Keun Kim, Jin-Bae Kim, Changsoo Kim, Jun Joung, Boyoung Korean J Intern Med Original Article BACKGROUND/AIMS: Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are more convenient to administer than warfarin, their lack of monitoring may predispose patients to nonpersistence. We compared the persistence of NOAC and VKA treatment for AF in real-world practice. METHODS: In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 7,013 patients with nonvalvular AF (mean age 67.2 ± 10.9 years, women 36.4%) were consecutively enrolled between June 2016 and June 2017 from 10 tertiary hospitals in Korea. This study included 3,381 patients who started OAC 30 days before enrollment (maintenance group) and 572 patients who newly started OAC (new-starter group). The persistence rate of OAC was evaluated. RESULTS: In the maintenance group, persistence to OAC declined during 6 months, to 88.3% for VKA and 95.5% for NOAC (p < 0.0001). However, the persistence rate was not different among NOACs. In the new-starter group, persistence to OAC declined during 6 months, to 78.9% for VKA and 92.1% for NOAC (p < 0.0001). The persistence rate was lower for rivaroxaban (83.7%) than apixaban (94.6%) and edoxaban (94.1%, p < 0.001). In the new-starter group, diabetes, valve disease, and cancer were related to nonpersistence of OAC. CONCLUSIONS: Nonpersistence was significantly lower with NOAC than VKA in both the maintenance and new-starter groups. In only the new-starter group, apixaban or edoxaban showed higher persistence rates than rivaroxaban. The Korean Association of Internal Medicine 2020-01 2019-04-25 /pmc/articles/PMC6960047/ /pubmed/31014064 http://dx.doi.org/10.3904/kjim.2017.415 Text en Copyright © 2020 The Korean Association of Internal Medicine 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 unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Kim, Hyeongsoo Lee, Young Soo Kim, Tae-Hoon Cha, Myung-Jin Lee, Jung Myung Park, Junbeom Park, Jin-Kyu Kang, Ki-Woon Shim, Jaemin Uhm, Jae-Sun Park, Hyung Wook Choi, Eue-Keun Kim, Jin-Bae Kim, Changsoo Kim, Jun Joung, Boyoung A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
title | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
title_full | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
title_fullStr | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
title_full_unstemmed | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
title_short | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
title_sort | prospective survey of the persistence of warfarin or noac in nonvalvular atrial fibrillation: a comparison study of drugs for symptom control and complication prevention of atrial fibrillation (code-af) |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960047/ https://www.ncbi.nlm.nih.gov/pubmed/31014064 http://dx.doi.org/10.3904/kjim.2017.415 |
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