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)

Hyeongsoo Kim, Young Soo Lee, Tae Hoon Kim, Myung Jin Cha, Jung Myung Lee, Junbeom Park, Jin Kyu Park, Ki Woon Kang, Jaemin Shim, Jae Sun Uhm, Hyung Wook Park, Eue Keun Choi, Jin Bae Kim, Changsoo Kim, Jun Kim, Boyoung Joung

Research output: Contribution to journalArticle

1 Citation (Scopus)

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] regis-try), 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.

Original languageEnglish
Pages (from-to)99-108
Number of pages10
JournalKorean Journal of Internal Medicine
Volume35
Issue number1
DOIs
Publication statusPublished - 2020 Jan 1

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Drug and Narcotic Control
Warfarin
Anticoagulants
Atrial Fibrillation
Vitamin K
Maintenance
Korea
Surveys and Questionnaires
Tertiary Care Centers
Registries
Stroke
Guidelines
Physicians
Neoplasms

Keywords

  • Anticoagulants
  • Apixaba
  • Atrial fibrillation
  • Dabigatran
  • Rivaroxaban

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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). / Kim, Hyeongsoo; Lee, Young Soo; Kim, Tae Hoon; Cha, Myung Jin; Lee, Jung Myung; Park, Junbeom; Park, Jin Kyu; Kang, Ki Woon; Shim, Jaemin; Uhm, Jae Sun; Park, Hyung Wook; Choi, Eue Keun; Kim, Jin Bae; Kim, Changsoo; Kim, Jun; Joung, Boyoung.

In: Korean Journal of Internal Medicine, Vol. 35, No. 1, 01.01.2020, p. 99-108.

Research output: Contribution to journalArticle

Kim, Hyeongsoo ; Lee, Young Soo ; Kim, Tae Hoon ; Cha, Myung Jin ; Lee, Jung Myung ; Park, Junbeom ; Park, Jin Kyu ; Kang, Ki Woon ; Shim, Jaemin ; Uhm, Jae Sun ; Park, Hyung Wook ; Choi, Eue Keun ; Kim, Jin Bae ; Kim, Changsoo ; Kim, Jun ; Joung, Boyoung. / 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). In: Korean Journal of Internal Medicine. 2020 ; Vol. 35, No. 1. pp. 99-108.
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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] regis-try), 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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T2 - A comparison study of drugs for symptom control and complication prevention of atrial fibrillation (code-af)

AU - Kim, Hyeongsoo

AU - Lee, Young Soo

AU - Kim, Tae Hoon

AU - Cha, Myung Jin

AU - Lee, Jung Myung

AU - Park, Junbeom

AU - Park, Jin Kyu

AU - Kang, Ki Woon

AU - Shim, Jaemin

AU - Uhm, Jae Sun

AU - Park, Hyung Wook

AU - Choi, Eue Keun

AU - Kim, Jin Bae

AU - Kim, Changsoo

AU - Kim, Jun

AU - Joung, Boyoung

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N2 - 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] regis-try), 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.

AB - 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] regis-try), 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.

KW - Anticoagulants

KW - Apixaba

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