AI Article Synopsis
- The study aimed to compare the rates of discontinuation between warfarin and direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) being treated for stroke prevention.
- Data was collected from 10,005 AF patients enrolled in the ORBIT-AF II Registry over a period from February 2013 to July 2017, using various statistical methods to analyze discontinuation rates and predictors.
- Results showed that at 12 months, the discontinuation rate was higher for DOACs (15.3%) compared to warfarin (12.7%), and discontinuing either treatment was linked to a higher risk of all-cause mortality and cardiovascular death.
Article Abstract
Unlabelled: While oral anticoagulation is a cornerstone of stroke prevention therapy in atrial fibrillation (AF), few studies have evaluated comparative discontinuation rates in clinical practice. The objective of this study is to evaluate discontinuation rates among patients on warfarin and direct oral anticoagulants (DOACs) in clinical practice.
Methods: The ORBIT-AF II Registry enrolled 10,005 total AF patients with a CHADSVASc score of ≥2 on warfarin or DOACs from 235 clinical practices across the US from February 13, 2013 and July 12, 2017. Descriptive statistics and multivariable Cox regression modeling were used to describe baseline characteristics and predictors of discontinuation. Unadjusted and adjusted discontinuation rates and 95% confidence intervals (CI) were calculated using Cox proportional hazards models and propensity score adjustment, respectively.
Results: At baseline, 16.4% (N = 1642/10,005) were treated with warfarin, 83.6% (N = 8363/10,005) with DOACs and 1498/10,005 patients (15.0%) discontinued therapy [warfarin = 236/1642 (14.4%) vs DOACs = 1262/8363 (15.1%)]. At 6 and 12 months respectively, among 7049 patients with a new diagnosis of AF within 6 months, adjusted discontinuation rates for warfarin versus DOACs were as follows: [6 months: 7.9%, 95%CI (6.8%-9.0%) vs 9.6% (8.4%-10.7%), P = .16]; [12 months: 12.7% (11.0%-14.3%) vs 15.3% (13.6%-16.9%), P = .02)]. Patients who discontinued therapy with warfarin or DOACs had higher risk of adverse clinical outcomes including: all-cause mortality and cardiovascular death (CV) than those who continued treatment.
Conclusion: In a community based AF cohort, adjusted rates of discontinuation at 12-months were higher in DOAC-treated versus VKA-treated patients. Discontinuation of oral anticoagulation was associated with increased absolute risk of all-cause mortality and CV death.
Clinical Trial Registration: URL:https://clinicaltrials.gov. Unique Identifier: NCT01701817.
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| http://dx.doi.org/10.1016/j.ahj.2020.04.016 | DOI Listing |
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