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Patterns of long‐term use of non‐vitamin K antagonist oral anticoagulants for non‐valvular atrial fibrillation: Quebec observational study
Author(s) -
Douros Antonios,
Renoux Christel,
Coulombe Janie,
Suissa Samy
Publication year - 2017
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4333
Subject(s) - medicine , discontinuation , hazard ratio , vitamin k antagonist , atrial fibrillation , proportional hazards model , odds ratio , cohort , cohort study , confidence interval , warfarin
Abstract Purpose Studies on long‐term utilization of non‐vitamin K antagonist oral anticoagulants (NOACs) in non‐valvular atrial fibrillation (NVAF) are scarce. We evaluated predictors of use and long‐term persistence of NOACs in a real‐world setting. Methods This population‐based cohort study used the computerized databases of the Canadian Province of Quebec's health insurance. Patients with a first NVAF diagnosis from 2011 until 2014 were included. A logistic regression model yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for predictors of treatment initiation with NOACs versus VKAs. Cox proportional hazards models yielded adjusted hazard ratios (HRs) and 95% CIs for predictors of switching from VKAs to NOACs versus remaining on VKAs, and for predictors of discontinuation of anticoagulation treatment. Results Of the 62 867 newly diagnosed NVAF patients, 14 646 initiated NOACs and 17 685 VKAs. Initiation with NOACs was less likely for patients ≥ 80 years old (OR 0.55, 95% CI 0.41–0.73) or with CHA 2 DS 2 ‐VASc ≥ 2 (OR 0.49, 95% CI 0.42–0.57). Switching from VKAs to NOACs was less likely for patients with chronic kidney disease (HR 0.53, 95% CI 0.48–0.59). After 3 years, persistence was 54% with NOACs and 25% with VKAs. Discontinuation of anticoagulation treatment was less likely for patients ≥ 80 years old (HR 0.47, 95% CI 0.40–0.55) or with CHA 2 DS 2 ‐VASc ≥ 2 (HR 0.64, 95% CI 0.57–0.70). Conclusions Older, high‐risk patients are less likely to initiate NOACs than VKAs. NOAC users show a higher long‐term persistence than VKA users, and older, high‐risk patients are less likely to discontinue anticoagulation treatment.