Korean J Intern Med.
2020 Jan;35(1):99-108. 10.3904/kjim.2017.415.
A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF)
- Affiliations
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- 1Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- 2Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
- 3Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 4Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
- 5Department of Cardiology, Ewha Womans University School of Medicine, Seoul, Korea
- 6Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea
- 7Division of Cardiology, Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
- 8Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
- 9Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- 10Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- 11Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Korea
- KMID: 2501991
- DOI: http://doi.org/10.3904/kjim.2017.415
Abstract
- Background/Aims
Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are more convenient to administer than warfarin, their lack of monitoring may predispose patients to nonpersistence. We compared the persistence of NOAC and VKA treatment for AF in real-world practice.
Methods
In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 7,013 patients with nonvalvular AF (mean age 67.2 ± 10.9 years, women 36.4%) were consecutively enrolled between June 2016 and June 2017 from 10 tertiary hospitals in Korea. This study included 3,381 patients who started OAC 30 days before enrollment (maintenance group) and 572 patients who newly started OAC (new-starter group). The persistence rate of OAC was evaluated.
Results
In the maintenance group, persistence to OAC declined during 6 months, to 88.3% for VKA and 95.5% for NOAC (p < 0.0001). However, the persistence rate was not different among NOACs. In the new-starter group, persistence to OAC declined during 6 months, to 78.9% for VKA and 92.1% for NOAC (p < 0.0001). The persistence rate was lower for rivaroxaban (83.7%) than apixaban (94.6%) and edoxaban (94.1%, p < 0.001). In the new-starter group, diabetes, valve disease, and cancer were related to nonpersistence of OAC.
Conclusions
Nonpersistence was significantly lower with NOAC than VKA in both the maintenance and new-starter groups. In only the new-starter group, apixaban or edoxaban showed higher persistence rates than rivaroxaban.
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