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11 April 2019 : Clinical Research  

Long-Term Persistence with Newly-Initiated Warfarin or Non-VKA Oral Anticoagulant (NOAC) in Patients with Non-Valvular Atrial Fibrillation: Insights from the Prospective China-AF Registry

Chang Liu1ABCDEF, Xin Du1ABCDEF, Chao Jiang1AB, Liu He1BCD, San-Shuai Chang1ABC, Xue-Yuan Guo1AE, Rong-Hui Yu1DE, De-Yong Long1DE, Rong Bai1BDEF, Nian Liu1AF, Cai-Hua Sang1EF, Chen-Xi Jiang1CD, Jian-Zeng Dong1CD, Gregory Y.H. Lip23ABCD, Chang-Sheng Ma1ABCDEFG*

DOI: 10.12659/MSM.915875

Med Sci Monit 2019; 25:2649-2657

Abstract

BACKGROUND: Oral anticoagulants (OACs) such as warfarin and non-VKA oral anticoagulants (NOACs) have been recommended for patients with atrial fibrillation (AF) who are at risk for stroke. Whether NOACs have a higher persistence than warfarin is still unclear. This is especially true in China.

MATERIAL AND METHODS: Data from a large hospital-based cohort in China (China-AF Registry) from 2011 to 2017 were used for this study. Non-valvular AF patients with newly initiated OACs were included. A time-to-event approach was used to analyze patient persistence. The survival distributions of persistence were compared using the log-rank test. A multivariable Cox regression model was used to explore predictors of warfarin and NOACs non-persistence.

RESULTS: Patients with newly initiated warfarin (n=4845) or NOACs (n=854) were included in this study. Persistence rates at 1, 2, and 3 years were 93.2%, 89.4%, and 87.2% in the warfarin group and 88.8%, 84.3%, and 81.3% in the NOAC group respectively. Non-persistence was significantly higher with NOACs than with warfarin. On multivariate analysis, age <75 years old, outpatient clinic visits, asymptomatic AF, paroxysmal AF, duration of AF <3 years, history of peptic ulcer, and no previous TIA, stroke or thromboembolism were strong predictors of warfarin non-persistence, while in the NOACs group, age <75 years old, outpatient clinic visits, lower education status and no history of congestive heart failure were predictors.

CONCLUSIONS: Treatment persistence of NOACs was lower than that of warfarin among Chinese patients with AF. Patients with characteristics of non-persistence predictors need special attention to maintain their therapy.

Keywords: Anticoagulants, Atrial Fibrillation, medication adherence, Aged, China, Kaplan-Meier Estimate, Prospective Studies, Registries, Time Factors, Treatment Outcome, Vitamin K, Warfarin

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750