title: 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.).
  
  
  CONCLUSIONS
  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.
authors: a Department of Interventional Cardiology , Heart Institute, University of Pécs , Pécs , Hungary.
authors: András
authors: A
authors: Komócsi
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000069604:Dabigatran / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D000069552:Rivaroxaban / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Anticoagulant adherence; NOACS; Non-vitamin-K-antagonist oral anticoagulants; Vitamin K antagonists