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  • Discontinuation of non-Vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation: a population-based cohort study using primary care data from The Health Improvement Network in the UK

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Epidemiology
Original research
Discontinuation of non-Vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation: a population-based cohort study using primary care data from The Health Improvement Network in the UK
  1. Ana Ruigómez1,
  2. Pareen Vora2,
  3. Yanina Balabanova2,
  4. Gunnar Brobert3,
  5. Luke Roberts4,
  6. Samuel Fatoba5,
  7. Oscar Fernandez1,
  8. Luis Alberto García Rodríguez1
  1. 1 Pharmacoepidemiology, Spanish Centre for Pharmacoepidemiological Research, Madrid, Spain
  2. 2 Epidemiology, Bayer AG, Berlin, Germany
  3. 3 Epidemiology, Bayer AB, Stockholm, Sweden
  4. 4 Study Medical Experts, Bayer plc, Reading, UK
  5. 5 Medical Affairs, Bayer plc, Reading, UK
  1. Correspondence to Dr Ana Ruigómez; aruigomez{at}ceife.es

Abstract

Objective To determine discontinuation rates, patterns of use and predictors of discontinuation of non-vitamin K antagonist oral anticoagulants (NOACs) among patients with non-valvular atrial fibrillation (NVAF) in the first year of therapy.

Design Population-based cohort study.

Setting UK primary care.

Population 11 481 patients with NVAF and a first prescription (index date) for apixaban, dabigatran or rivaroxaban (January 2012 to December 2016) with at least 1 year of follow-up and at least one further NOAC prescription in the year following the index date were identified. 1 year rates and patterns of discontinuation were described.

Primary and secondary outcome measures Outcome measures were the percentage of patients who, in the first year from starting NOAC therapy, discontinued with their oral anticoagulant (OAC) therapy (discontinuation was defined as a gap in OAC therapy of >30 days); switched OAC within 30 days; discontinued and reinitiated OAC therapy. Predictors of discontinuation were also evaluated.

Results 1 year discontinuation rates according to the index NOAC were 26.1% for apixaban, 40.0% for dabigatran and 29.6% for rivaroxaban. Reinitiation rates were 18.1% for apixaban, 21.7% for dabigatran and 17.3% for rivaroxaban, and switching rates were 2.8% for apixaban, 8.8% for dabigatran and 4.9% for rivaroxaban. More than 93% of reinitiations were with the index NOAC. Patients starting on dabigatran were more likely to switch OAC therapy than those starting on apixaban; ORs 4.28 (95% CI 3.24 to 5.65) for dabigatran and 1.89 (95% CI 1.49 to 2.39) for rivaroxaban. Severely reduced renal function was a predictor of any discontinuation, OR 1.77 (95% CI 1.28 to 2.44).

Conclusion While the majority of patients with NVAF in the UK initiating NOAC treatment received continuous therapy in the first year of treatment, a substantial proportion of patients experienced gaps in treatment leaving them less protected against thromboembolism during these periods.

  • epidemiology
  • anticoagulant
  • atrial fibrillation
  • discontinuation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-031342

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    Footnotes

    • Contributors LR and SF developed the concept for the research study. LR, SF, LAGR, AR, GB, PV, and YB planned the study. AR, LAGR and OF conducted the study. All authors interpreted the data, reviewed drafts of the manuscript, and approved the final version of the article for publication.

    • Funding This work was supported by Bayer AG. PV and YB (both employees of Bayer AG) were involved in the study conception, data interpretation, and the review of manuscript drafts. The funder had no role in the study design, or in the collection or analysis of data.

    • Competing interests LAGR, OF and AR work for the Spanish Centre for Pharmacoepidemiologic Research (Madrid, Spain), which has received research funding from Bayer AG. LAGR also declares honoraria for serving on advisory boards for Bayer AG. PV and YB, are employees of Bayer AG (Germany), the funder of the study; GB is an employee of Bayer AB, (Stockholm, Sweden); LR and SF are employees of Bayer PLC (Reading, UK). LR and SF declare shares in Bayer.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved by the Independent Scientific Research Committee for THIN (reference SRC 17THIN014). Data collection for THIN was approved by the South East Multicentre Research Ethics Committee in 2003 and individual studies using THIN data do not require separate ethical approval if only anonymised THIN data are used.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available from the corresponding author upon reasonable request.

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