Discontinuation of anticoagulant treatment: from clinical trials to medication persistence

Abstract

Background:

The new generation, non-vitamin K antagonist oral anticoagulants are used in an increasing frequency, partially replacing the vitamin K antagonists in several fields of anticoagulation. Efficacy of the preventive oral anticoagulant regime, however, may be compromised by patient non-compliance.

Methods:

The authors analyzed treatment discontinuation frequencies in phase 3 trials of anticoagulant treatment in non-valvular atrial fibrillation in a frequentist random effect metaanalysis and in Bayesian multiple treatment network comparison.

Results:

Frequency of discontinuations are heterogeneous and highly inconsistent (Chi2 test for heterogeneity p < 0.001, I2 test for inconsistency 95.1%). Discontinuations were the most frequent with dabigatran followed by rivaroxaban, warfarin, edoxaban and apixaban. Rivaroxaban were less frequently discontinued when compared to the two doses of dabigatran. (OR 0.80; 95% CI: 0.71–0.91 versus 150 mg b.i.d., and OR: 0.77; 95% CI: 0.68–0.87 versus 110 mg b.i.d.).

Conclusion:

Important differences exist among the treatment adherence of different anticoagulant protocols. Discontinuation rates experienced during the clinical trials may predict the real life patient adherence.

Keywords: :

• Anticoagulant adherence
• NOACS
• Non-vitamin-K-antagonist oral anticoagulants
• Vitamin K antagonists

Transparency

Declaration of funding

This editorial was not funded.

Declaration of financial/other relationships

A.K. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article.

The CMRO peer reviewer on this manuscript has no relevant financial or other relationships to disclose.