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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)

Korean Journal of Internal Medicine 2020년 35권 1호 p.99 ~ 108
김형수 ( Kim Hyeong-Soo ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology

이영수 ( Lee Young-Soo ) - Daegu Catholic University Medical Center Division of Cardiology
김태훈 ( Kim Tae-Hoon ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
차명진 ( Cha Myung-Jin ) - Seoul National University Hospital Department of Internal Medicine
이정명 ( Lee Jung-Myung ) - Kyung Hee University Hospital Division of Cardiology
박준범 ( Park Jun-Beom ) - Ewha Womans University College of Medicine Department of Cardiology
박진규 ( Park Jin-Kyu ) - Hanyang University Seoul Hospital Department of Cardiology
강기운 ( Kang Ki-Woon ) - Eulji University Hospital Department of Internal Medicine
심재민 ( Shim Jae-Min ) - Korea University Medical Center Department of Internal Medicine
엄재선 ( Uhm Jae-Sun ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
박형욱 ( Park Hyung-Wook ) - Chonnam National University Hospital Department of Cardiology
최의근 ( Choi Eue-Keun ) - Seoul National University Hospital Department of Internal Medicine
김진배 ( Kim Jin-Bae ) - Kyung Hee University Hospital Division of Cardiology
김창수 ( Kim Chang-Soo ) - Yonsei University College of Medicine Department of Preventive Medicine
김준 ( Kim Jun ) - University of Ulsan College of Medicine Asan Medical Center Heart Institute
정보영 ( Joung Bo-Young ) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology

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.

키워드

Atrial fibrillation; Anticoagulants; Dabigatran; Rivaroxaban; Apixaban
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