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J Thromb Thrombolysis. 2019 Nov 5. doi: 10.1007/s11239-019-01986-8. [Epub ahead of print]

Medication adherence to rivaroxaban and dabigatran in patients with non-valvular atrial fibrillation: a meta-analysis.

Author information

1
College of Pharmacy, Medical University of South Carolina, 280 Calhoun Street, QE213C MSC140, Charleston, SC, 29425, USA.
2
College of Pharmacy, Medical University of South Carolina, 280 Calhoun Street, QE213C MSC140, Charleston, SC, 29425, USA. weeda@musc.edu.

Abstract

Several real-world studies have evaluated adherence to direct acting oral anticoagulants in patients with non-valvular atrial fibrillation (NVAF); however, these studies have not been systematically summarized. We performed a meta-analysis to compare adherence to rivaroxaban versus dabigatran therapy in United States (US) patients with NVAF in a real-world setting. Medline and Scopus were searched from January 2010 to August 2018 using keywords and MeSH terms related to adherence and oral anticoagulants. We included real-world studies of US adults with NVAF comparing adherence to dabigatran and rivaroxaban. Studies evaluating adherence by a measure other than proportion of days covered (PDC) were excluded. The proportion of patients with a PDC ≥ 80 (a commonly utilized definition of adherence) served as the primary outcome of interest. We conducted meta-analysis of non-overlapping studies using the Hartung-Knapp random-effects model to estimate risk ratios (RRs) with corresponding 95% confidence intervals (CIs). We included 5 studies evaluating 80,230 patients (range 2667-22,571). Median follow-up across studies was 6 months (range 3-12 months). The proportion of patients with a PDC ≥ 80 ranged from 59.5 to 83.5% for rivaroxaban users and 57.3 to 78.3% for dabigatran users. Upon meta-analysis, rivaroxaban use was associated with increased adherence compared with dabigatran use (RR  1.08; 95% CI  1.03-1.12; I2 = 88%). In conclusion, rivaroxaban was associated with increased adherence when compared to dabigatran in ~ 80,000 patients in a real-world setting. Possible explanations for this include dosing frequency or patient tolerance.

KEYWORDS:

Atrial fibrillation; Direct oral anticoagulant; Medication adherence; Proportion of days covered

PMID:
31691066
DOI:
10.1007/s11239-019-01986-8

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