title: Drug persistence with rivaroxaban therapy in atrial fibrillation patients-results from the Dresden non-interventional oral anticoagulation registry.
abstract: OBJECTIVE
  Worldwide, rivaroxaban is increasingly used for stroke prevention in atrial fibrillation (SPAF) but little is known about the rates of or reasons for rivaroxaban discontinuations in daily care. Using data from a prospective, non-interventional oral anticoagulation (NOAC) registry, we analysed rivaroxaban treatment persistence.
  
  
  RESULTS
  Persistence with rivaroxaban in SPAF was assessed in an ongoing, prospective, non-interventional registry of >2600 NOAC patients from daily care using the Kaplan-Meier time-to-first-event analysis. Reasons for and management of rivaroxaban discontinuation were assessed. Potential baseline risk factors for treatment discontinuation were evaluated using Cox regression analysis. Between October 2011 and April 2014, 1204 rivaroxaban SPAF patients were enrolled [39.3% switched from vitamin K antagonists (VKAs) and 60.7% newly treated patients]. Of these, 223 patients (18.5%) stopped rivaroxaban during follow-up (median 544 days), which translates into a discontinuation rate of 13.6 (95% CI 11.8-15.4) per 100 patient-years. Most common reasons for treatment discontinuations were bleeding complications (30% of all discontinuations), followed by other side-effects (24.2%) and diagnosis of stable sinus rhythm (9.9%). A history of chronic heart failure (HR 1.43; 95% CI 1.09-1.87; P = 0.009) or diabetes (HR 1.39; 95% CI 1.06-1.82; P = 0.018) were the only statistically significant baseline risk factors for rivaroxaban discontinuation. After discontinuation of rivaroxaban, patients received antiplatelet therapy (31.8%), VKA (24.2%), another NOAC (18.4%), heparin (9.9%), or nothing (15.7%).
  
  
  CONCLUSIONS
  Our data indicate that overall persistence with rivaroxaban therapy is high, with a discontinuation rate of ∼15% in the first year of treatment and few additional discontinuations thereafter.
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany jan.beyer@uniklinikum-dresden.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Beyer-Westendorf
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany.
authors.forename: Kati
authors.initials: K
authors.lastname: Förster
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Ebertz
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Gelbricht
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schreier
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Göbelt
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Michalski
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Endig
authors.affiliation: ClinStat GmbH, Institute for Clinical Research and Statistics, Max-Planck-Str. 22a, Cologne D-50858, Germany.
authors.forename: Kurtulus
authors.initials: K
authors.lastname: Sahin
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany.
authors.forename: Luise
authors.initials: L
authors.lastname: Tittl
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Technical University Dresden, Fetscherstrasse 74, Dresden D-01307, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiss
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology*; D017723:Drug Utilization Review; D065427:Factor Xa Inhibitors / Q000008:administration & dosage; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D000069552:Rivaroxaban / Q000008:administration & dosage*; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000706:statistics & numerical data*
chemical_list: D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban
keywords: Anticoagulants; Atrial fibrillation; NOAC; Persistence; Rivaroxaban