Discontinuation of anticoagulant treatment: from clinical trials to medication persistence. (3rd October 2015)

• Record Type: Journal Article
• Authors: Komócsi, András
• Is Part Of: Current medical research and opinion. Volume 31:Number 10(2015:Oct.)
• Page Start: 1841
• Page End: 1844
• Publication Date: 2015-10-03
• Subjects: Anticoagulant adherence -- NOACS -- Non-vitamin-K-antagonist oral anticoagulants -- Vitamin K antagonists; Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1185/03007995.2015.1086991
• Languages: English
• ISSNs: 0300-7995

Abstract

Abstract: Background: The new generation, non-vitamin K antagonist oral anticoagulants are used in an increasing frequency, partially replacing the vitamin K antagonists in several fields of anticoagulation. Efficacy of the preventive oral anticoagulant regime, however, may be compromised by patient non-compliance. Methods: The authors analyzed treatment discontinuation frequencies in phase 3 trials of anticoagulant treatment in non-valvular atrial fibrillation in a frequentist random effect metaanalysis and in Bayesian multiple treatment network comparison. Results: Frequency of discontinuations are heterogeneous and highly inconsistent (Chi2 test for heterogeneity p < 0.001, I2 test for inconsistency 95.1%). Discontinuations were the most frequent with dabigatran followed by rivaroxaban, warfarin, edoxaban and apixaban. Rivaroxaban were less frequently discontinued when compared to the two doses of dabigatran. (OR 0.80; 95% CI: 0.71–0.91 versus 150 mg b.i.d., and OR: 0.77; 95% CI: 0.68–0.87 versus 110 mg b.i.d.). Conclusion: Important differences exist among the treatment adherence of different anticoagulant protocols. Discontinuation rates experienced during the clinical trials may predict the real life patient adherence.