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Utilization and long‐term persistence of direct oral anticoagulants among patients with nonvalvular atrial fibrillation and liver disease
Author(s) -
Douros Antonios,
Cui Ying,
Platt Robert W.,
Filion Kristian B.,
Sebastiani Giada,
Renoux Christel
Publication year - 2022
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.15046
Subject(s) - medicine , discontinuation , atrial fibrillation , hazard ratio , stroke (engine) , odds ratio , proportional hazards model , cohort , population , lower risk , confidence interval , mechanical engineering , environmental health , engineering
Aims We characterized the utilization and long‐term treatment persistence of direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (NVAF) and liver disease. Method Using the UK Clinical Practice Research Datalink, we assembled a population‐based cohort of NVAF patients with liver disease initiating oral anticoagulants between 2011 and 2020. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) of the association between patient characteristics and initiation of DOACs vs vitamin K antagonists (VKAs). Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs of the association between patient characteristics and the switch from VKAs to DOACs vs remaining on VKAs. We also assessed the 5‐year treatment persistence with DOACs vs VKAs, and whether ischemic stroke or bleeding preceded treatment discontinuation. Results Our cohort included 3167 NVAF patients with liver disease initiating DOACs (n = 2247, 71%) or VKAs (n = 920, 29%). Initiators of DOACs were more likely to have prior ischemic stroke (OR 1.44, 95% CI 1.12‐1.85) than VKA initiators but less likely to have used antiplatelet agents (OR 0.66, 95% CI 0.53‐0.82). Patients switching to DOACs were more likely to have used selective serotonin reuptake inhibitors (HR 1.64, 95% CI 1.13‐2.37) than those remaining on VKAs. At 5 years, 31% of DOAC initiators and 9% of VKA initiators remained persistent. Only few patients were diagnosed with ischemic stroke or bleeding prior to treatment discontinuation. Conclusion Most NVAF patients with liver disease initiated treatment with DOACs. Long‐term persistence with DOACs was higher than with VKAs but remained relatively low.