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Atrial fibrillation(AF) is the most clinically prevalent type of tachyarrhythmia 1,2) and is a potential risk factor for stroke 3,4) . Anticoagulant therapy with the vitamin K antagonist warfarin reduces the risk of AF-related stroke 4,5) . Recently, several nonvitamin K antagonist oral anticoagulants (NOACs) have been developed. Landmark phase 3 randomized clinical trials(RCTs) [the Randomized Evaluation of Long-Term Anticoagulation Therapy(RE-LY)trial 6) , the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) 7) , the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation(ARISTOTLE)trial 8) , and the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48(ENGAGE AF-TIMI 48)trial 9) ]have demonstrated that NOACs are at least as safe and effective as warfarin in preventing stroke/systemic embolisms in non-valvular AF (NVAF)patients 6−10) . NOACs are mainly or partially eliminated by the kidneys(dabigatran, 80% ; rivaroxaban, 33% ; apixaban, 25% ; and edoxaban, 50%), and their blood drug concentrations in patients with renal impairment are higher than in subjects with normal renal function 11−14) . Patients with creatinine clearance (CrCl)<30 mL/min(<25 mL/min in the ARISTOTLE trial) were excluded from phase 3 RCTs 6−9) . In a sub-analysis of the RE-LY trial, ischemic stroke and bleeding outcomes correlated with dabigatran plasma concentrations 15) . Therefore, the individual treatment benefits of NOACs, especially those with high renal excretion ratios, may be influenced by an individual patientʼs renal function. In the real-world setting, adequate treatment persistence with the appropriate anticoagulation drugs is important for the prevention of stroke among at-risk NVAF patients. In a previous study, we reported a significantly lower persistence rate of prescribed NOACs within one year of treatment initiation compared to prescribed warfarin in Japanese patients with 臨床薬理 Jpn J Clin Pharmacol Ther 2016; 47(3): 115-122 115

rinshou yakuri/rinshō yakuri

&lt;b&gt;Renal Function and Treatment Persistence with Non-Vitamin K Antagonist Oral Anticoagulants in Japanese Patients with Atrial Fibrillation: A Single-Center Experience&lt;/b&gt;