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Observational Study
. 2020 Jan;35(1):99-108.
doi: 10.3904/kjim.2017.415. Epub 2019 Apr 25.

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  1 , Young Soo Lee  2 , Tae-Hoon Kim  1 , Myung-Jin Cha  3 , Jung Myung Lee  4 , Junbeom Park  5 , Jin-Kyu Park  6 , Ki-Woon Kang  7 , Jaemin Shim  8 , Jae-Sun Uhm  1 , Hyung Wook Park  9 , Eue-Keun Choi  3 , Jin-Bae Kim  4 , Changsoo Kim  10 , Jun Kim  11 , Boyoung Joung  1
Affiliations
Observational Study

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 et al. Korean J Intern Med. 2020 Jan.

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.

Conclusion: 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.

Keywords: Anticoagulants; Apixaban; Atrial fibrillation; Dabigatran; Rivaroxaban.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Flowchart of patient enrollment. AF, atrial fibrillation; OAC, oral anticoagulant; NOAC, non-vitamin K antagonist (VKA) OAC.
Figure 2.
Figure 2.
Kaplan-Meier curve free from persistence in the new-starter group. VAK, vitamin K antagonist.
Figure 3.
Figure 3.
Kaplan-Meier curve free from persistence in the maintenance group. VAK, vitamin K antagonist.
Figure 4.
Figure 4.
Change of oral anticoagulant method in the new-starter (A) and maintenance (B) groups. VAK, vitamin K antagonist.
See this image and copyright information in PMC

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