Real-World Study Compares Treatment Persistence, Discontinuation of Oral Anticoagulants in Afib Patients

Rivaroxaban, a non-vitamin K antagonist (VKA) oral anticoagulant, was found to have better persistence and lower discontinuation rates than, the VKA warfarin and the non-VKA, dabigatran.

Researchers used data from the US Truven Health MarketScan and included patients with non-valvular arterial fibrillation (NVAF) who initiated rivaroxaban, dabigatran, or warfarin treatment between November 1, 2011 and December 31, 2013.

A total of 32,634 patients were included in the final analysis. Persistence among rivaroxaban was 79.2% at the 3 month follow-up, 70.2% by month 6, 60.1% by the end of year 1, and 50.4% by the end of year 2. These proportions were consistently greater than those of dabigatran and warfarin, with corresponding rates of 69.6%, 57.8%, 44.7% and 30.6%; and 70.9%, 58.8%, 42.0%, and 26.5%, respectively. 

Compared with dabigatran, rivaroxaban was linked with considerably higher levels of persistence (HR 0.64, 95% CI 0.62–0.67), similarly rivaroxaban persistence levels were greater than warfarin (HR 0.62, 95% CI 0.59–0.64). Furthermore, use of rivaroxaban was tied to significantly lower rates of discontinuation than with dabigatran (HR 0.61, 95% CI 0.58–0.64) and warfarin (HR 0.65, 95% CI 0.62–0.68).

Since their approvals in October 2010 and November 2011, no single study has compared the real-world persistence and discontinuation rates of rivaroxaban and dabigatran.

The authors wrote that “considering the results of all these studies together there appears to be substantial evidence to suggest that rivaroxaban is associated with increased persistence compared with either VKAs or dabigatran.”

In addition, the authors suggested that “much needs to be done” to make patients with NVAF and their prescribers aware of the critical role of oral anticoagulants such as rivaroxaban in reducing the thromboembolic risk in the long run. They concluded by stating the need for future research to “evaluate whether the relatively high persistence/low discontinuation rates for rivaroxaban translate into lower rates of ischemic stroke and does not produce a higher risk of bleeding in patients with NVAF.”

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