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Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin.

Publication ,  Journal Article
Zalesak, M; Siu, K; Francis, K; Yu, C; Alvrtsyan, H; Rao, Y; Walker, D; Sander, S; Miyasato, G; Matchar, D; Sanchez, H
Published in: Circ Cardiovasc Qual Outcomes
September 1, 2013

BACKGROUND: Oral anticoagulation therapy is the primary tool in reducing stroke risk in patients with nonvalvular atrial fibrillation but is underused. Patients nonpersistent with therapy contribute to this underuse. The objective of this study was to compare persistence rates in newly diagnosed nonvalvular atrial fibrillation patients treated with warfarin versus dabigatran as their oral anticoagulation. METHODS AND RESULTS: US Department of Defense administrative claims were used to identify patients receiving warfarin or dabigatran between October 28, 2010, and June 30, 2012. Patient records were examined for a minimum of 12 months before index date to restrict the analyses to those newly diagnosed with nonvalvular atrial fibrillation and naive-to-treatment, identifying 1775 on warfarin and 3370 on dabigatran. Propensity score matching was used to identify 1745 matched pairs. Persistence was defined as time on therapy to discontinuation. Kaplan-Meier curves were used to depict persistence over time. Cox proportional hazards model was used to determine the factors significantly associated with persistence. Using a 60-day permissible medication gap, the persistence rates were higher for dabigatran than for warfarin at both 6 months (72% versus 53%) and 1 year (63% versus 39%). Patients on dabigatran with a low-to-moderate risk of stroke (CHADS2<2) or with a higher bleed risk (HEMORR2HAGES>3) had a higher likelihood of nonpersistence (hazard ratios, 1.37; 95% confidence interval, 1.17-1.60; P<0.001; and hazard ratios, 1.24; 95% confidence interval, 1.04-1.47; P=0.016). CONCLUSIONS: Patients who initiated dabigatran treatment were more persistent than patients who began warfarin treatment. Within each cohort, patients with lower stroke risk were more likely to discontinue therapy.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

September 1, 2013

Volume

6

Issue

5

Start / End Page

567 / 574

Location

United States

Related Subject Headings

  • beta-Alanine
  • Warfarin
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Proportional Hazards Models
  • Propensity Score
  • Odds Ratio
 

Citation

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Zalesak, M., Siu, K., Francis, K., Yu, C., Alvrtsyan, H., Rao, Y., … Sanchez, H. (2013). Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin. Circ Cardiovasc Qual Outcomes, 6(5), 567–574. https://doi.org/10.1161/CIRCOUTCOMES.113.000192
Zalesak, Martin, Kimberly Siu, Kevin Francis, Chen Yu, Hasmik Alvrtsyan, Yajing Rao, David Walker, et al. “Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin.Circ Cardiovasc Qual Outcomes 6, no. 5 (September 1, 2013): 567–74. https://doi.org/10.1161/CIRCOUTCOMES.113.000192.
Zalesak M, Siu K, Francis K, Yu C, Alvrtsyan H, Rao Y, et al. Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin. Circ Cardiovasc Qual Outcomes. 2013 Sep 1;6(5):567–74.
Zalesak, Martin, et al. “Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin.Circ Cardiovasc Qual Outcomes, vol. 6, no. 5, Sept. 2013, pp. 567–74. Pubmed, doi:10.1161/CIRCOUTCOMES.113.000192.
Zalesak M, Siu K, Francis K, Yu C, Alvrtsyan H, Rao Y, Walker D, Sander S, Miyasato G, Matchar D, Sanchez H. Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin. Circ Cardiovasc Qual Outcomes. 2013 Sep 1;6(5):567–574.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

September 1, 2013

Volume

6

Issue

5

Start / End Page

567 / 574

Location

United States

Related Subject Headings

  • beta-Alanine
  • Warfarin
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Proportional Hazards Models
  • Propensity Score
  • Odds Ratio