TY - JOUR
T1 - Early therapeutic persistence on dabigatran versus warfarin therapy in patients with atrial fibrillation
T2 - results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry
AU - Jackson, Larry R.
AU - Kim, Sunghee
AU - Shrader, Peter
AU - Blanco, Rosalia
AU - Thomas, Laine
AU - Ezekowitz, Michael D.
AU - Ansell, Jack
AU - Fonarow, Gregg C.
AU - Gersh, Bernard J.
AU - Go, Alan S.
AU - Kowey, Peter R.
AU - Mahaffey, Kenneth W.
AU - Hylek, Elaine M.
AU - Peterson, Eric D.
AU - Piccini, Jonathan P.
N1 - Funding Information:
Funding The ORBIT-AF and ORBIT-AF II registries are sponsored by Janssen Scientific Affairs, LLC (Raritan, NJ).
Funding Information:
Conflict of interest Drs. Larry R. Jackson II reports honoraria from Biotronik Inc. Sung Hee Kim, Peter Shrader, Rosalia Blanco and Laine Thomas have no pertinent relationships related to the analysis presented. Dr. Jonathan P. Piccini Sr. receives research grants from ARCA biopharma, Boston Scientific, GE Healthcare, Johnson & Johnson, and ResMed; he also has received consulting fees from Janssen Pharmaceuticals, and Spectranetics. Dr. Bernard Gersh receives consulting fees from Ortho-McNeil-Janssen Pharmaceuticals. Dr. Ezekowitz receives consulting fees from Janssen Pharmaceuticals. Dr. Ansell receives consulting fees from Janssen pharmaceuticals. Dr. Hylek reports honoraria for consultancy from Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Janssen, Medtronic & Pfizer Dr. Gregg C. Fonarow receives consulting fees from Janssen Pharmaceuticals. Dr. Alan S. Go receives consulting fees from Janssen Pharmaceuticals. Dr. Kenneth W. Mahaffey receives research grants from Medtronic and St. Jude; he has also received consulting fees the American College of Cardiology, AstraZenaca, Bayer, Boehringer Ingelheim, Bristol My-ers Squibb, Eli Lilly, Elsevier, Forest, Glaxo-Smith-Kline, Johnson & Johnson, Medtronic, Merck, Portola Pharma, Spring Publishing, and The Medicines Company, WebMD. Dr. Peterson receives research grants from Eli Lilly & Company and Janssen Pharmaceutical Products; he also has received consulting fees from Boehringer Ingelheim, Janssen Pharmaceutical Products, Merck & Co., and Sanofi Aventis. Dr. Peter Kowey receives consulting fees from Johnson and Johnson.
Funding Information:
Drs. Larry R. Jackson II reports honoraria from Biotronik Inc. Sung Hee Kim, Peter Shrader, Rosalia Blanco and Laine Thomas have no pertinent relationships related to the analysis presented. Dr. Jonathan P. Piccini Sr. receives research grants from ARCA biopharma, Boston Scientific, GE Healthcare, Johnson & Johnson, and ResMed; he also has received consulting fees from Janssen Pharmaceuticals, and Spectranetics. Dr. Bernard Gersh receives consulting fees from Ortho-McNeil-Janssen Pharmaceuticals. Dr. Ezekowitz receives consulting fees from Janssen Pharmaceuticals. Dr. Ansell receives consulting fees from Janssen pharmaceuticals. Dr. Hylek reports honoraria for consultancy from Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Janssen, Medtronic & Pfizer Dr. Gregg C. Fonarow receives consulting fees from Janssen Pharmaceuticals. Dr. Alan S. Go receives consulting fees from Janssen Pharmaceuticals. Dr. Kenneth W. Mahaffey receives research grants from Medtronic and St. Jude; he has also received consulting fees the American College of Cardiology, AstraZenaca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Elsevier, Forest, Glaxo-Smith-Kline, Johnson & Johnson, Medtronic, Merck, Portola Pharma, Spring Publishing, and The Medicines Company, WebMD. Dr. Peterson receives research grants from Eli Lilly & Company and Janssen Pharmaceutical Products; he also has received consulting fees from Boehringer Ingelheim, Janssen Pharmaceutical Products, Merck & Co., and Sanofi Aventis. Dr. Peter Kowey receives consulting fees from Johnson and Johnson.
Publisher Copyright:
© 2018, The Author(s).
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Anticoagulation is highly effective for the prevention of stroke in patients with atrial fibrillation (AF) but it is dependent on patients continuing therapy. While studies have demonstrated suboptimal therapeutic persistence on warfarin, few have studied persistence rates with non vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran. We examined rates of continued use of dabigatran versus warfarin over 1 year among AF patients in the ORBIT-AF registry between June 29, 2010 and August 09, 2011. Multivariable logistic regression analysis was used to identify characteristics associated with 1-year persistent use of dabigatran therapy or warfarin. At baseline, 6.4 and 93.6% of 7150 AF patients were on dabigatran and warfarin, respectively. At 12 months, dabigatran-treated patients were less likely to have continued their therapy than warfarin-treated patients [Adjusted persistence rates: 66% (95% CI 60–72) vs. 82% (95% CI 80–84), p <.0001]. Predictors of dabigatran persistence included: CHA2DS2-VASc risk scores ≥ 2 OR 5.69, (95% CI 1.50–21.6) and BMI greater than 25 mg/m2 but less than 38 kg/m2 1.05 (1.01–1.09). Predictors of persistence on warfarin included: African American race (vs. White) 1.53 (1.07–2.19), Hispanic ethnicity (vs. White) 1.66 (1.06–2.60), paroxysmal and persistent AF (vs. new-onset) 1.68 (1.21–2.33) and 1.91 (1.35–2.69) respectively, LVH 1.40 (1.08–1.81), and CHA2DS2-VASc risk scores ≥ 2 1.94 (1.18–3.19). While 1-year persistence rates for dabigatran were lower than warfarin, persistence rates for both agents were not ideal. Future studies evaluating contemporary persistence are needed in order to assist in better targeting interventions aimed to improve anticoagulation persistence.
AB - Anticoagulation is highly effective for the prevention of stroke in patients with atrial fibrillation (AF) but it is dependent on patients continuing therapy. While studies have demonstrated suboptimal therapeutic persistence on warfarin, few have studied persistence rates with non vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran. We examined rates of continued use of dabigatran versus warfarin over 1 year among AF patients in the ORBIT-AF registry between June 29, 2010 and August 09, 2011. Multivariable logistic regression analysis was used to identify characteristics associated with 1-year persistent use of dabigatran therapy or warfarin. At baseline, 6.4 and 93.6% of 7150 AF patients were on dabigatran and warfarin, respectively. At 12 months, dabigatran-treated patients were less likely to have continued their therapy than warfarin-treated patients [Adjusted persistence rates: 66% (95% CI 60–72) vs. 82% (95% CI 80–84), p <.0001]. Predictors of dabigatran persistence included: CHA2DS2-VASc risk scores ≥ 2 OR 5.69, (95% CI 1.50–21.6) and BMI greater than 25 mg/m2 but less than 38 kg/m2 1.05 (1.01–1.09). Predictors of persistence on warfarin included: African American race (vs. White) 1.53 (1.07–2.19), Hispanic ethnicity (vs. White) 1.66 (1.06–2.60), paroxysmal and persistent AF (vs. new-onset) 1.68 (1.21–2.33) and 1.91 (1.35–2.69) respectively, LVH 1.40 (1.08–1.81), and CHA2DS2-VASc risk scores ≥ 2 1.94 (1.18–3.19). While 1-year persistence rates for dabigatran were lower than warfarin, persistence rates for both agents were not ideal. Future studies evaluating contemporary persistence are needed in order to assist in better targeting interventions aimed to improve anticoagulation persistence.
KW - Atrial fibrillation
KW - Dabigatran
KW - Oral anticoagulation
KW - Warfarin
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U2 - 10.1007/s11239-018-1715-1
DO - 10.1007/s11239-018-1715-1
M3 - Article
C2 - 30051164
AN - SCOPUS:85050746164
VL - 46
SP - 435
EP - 439
JO - Journal of Thrombosis and Thrombolysis
JF - Journal of Thrombosis and Thrombolysis
SN - 0929-5305
IS - 4
ER -