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Pharmacoepidemiol Drug Saf. 2017 Nov;26(11):1367-1377. doi: 10.1002/pds.4268. Epub 2017 Jul 28.

Adherence with direct oral anticoagulants in nonvalvular atrial fibrillation new users and associated factors: a French nationwide cohort study.

Author information

1
Department of Studies in Public Health, French National Health Insurance (Assurance maladie, CNAMTS), Paris Cedex, France.
2
Team Pharmacoepidemiology, Bordeaux Population Health Research Center, Inserm, Univ. Bordeaux, Bordeaux, France.
3
Pharmacologie, CHU de Bordeaux, Bordeaux, France.

Abstract

PURPOSE:

Direct oral anticoagulants (DOACs) have been promoted in patients with nonvalvular atrial fibrillation (nv-AF) as a more convenient alternative to vitamin K antagonists. We estimated 1-year dabigatran and rivaroxaban adherence rates in nv-AF patients and assessed associations between baseline patient characteristics and nonadherence.

METHODS:

This cohort study included OAC-naive nv-AF patients with no contraindications to OAC, who initiated dabigatran and rivaroxaban, using nationwide data from French national health care databases. One-year adherence was defined by the proportion of days covered of 80% or more over a fixed 1-year period after treatment initiation. Associations between nonadherence and baseline patient characteristics were assessed using multivariate logistic regression models.

RESULTS:

The population was composed of 11 141 dabigatran (women: 48%; mean age: 74 ± 10.7 y; ≥80 y: 34.9%) and 11 126 rivaroxaban (46.5%; 74 ± 10.9 y; 34.8%) new users. One-year adherence was 53.3% in dabigatran-treated and 59.9% in rivaroxaban-treated patients, consistent with numerous subgroup analyses. A switch to vitamin K antagonist was observed in 14.5% of dabigatran and 11.7% of rivaroxaban patients; 10.2% and 5.9% of patients switched to another DOAC, respectively; and 4.3% of patients died in the 2 cohorts. In patients who did not die or switch during the follow-up, 1-year adherence was 69.6% in dabigatran-treated and 72.3% in rivaroxaban-treated patients. Having concomitant ischemic heart diseases was associated with an increased risk of nonadherence in the 2 cohorts.

CONCLUSION:

In this real-life study, 1-year adherence to DOAC is poor in nv-AF new users. Despite the introduction of DOAC, adherence to OACs may remain a significant challenge in AF patients.

KEYWORDS:

French health care databases; adherence; atrial fibrillation; direct oral anticoagulants; pharmacoepidemiology

PMID:
28752560
PMCID:
PMC5697683
DOI:
10.1002/pds.4268
[Indexed for MEDLINE]
Free PMC Article

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