title: The safety and persistence of non-vitamin-K-antagonist oral anticoagulants in atrial fibrillation patients treated in a well structured atrial fibrillation clinic.
abstract: OBJECTIVE
  To examine the long-term persistence and safety of the non-vitamin-K-antagonist oral anticoagulants (NOACs) dabigatran (D), rivaroxaban (R) and apixaban (A) in patients with non-valvular atrial fibrillation (AF) treated in the framework of a well structured, nurse-based AF unit for initiation and follow-up of NOAC.
  
  
  METHODS
  Retrospective clinical data were collected for 766 consequent patients from a single cardiology outpatient clinic incorporating the AF unit.
  
  
  RESULTS
  The follow-up time, median (q1-q3), was 367 days (183-493) for D patients (n = 233), 432 days (255-546) for R patients (n = 282) and 348 days (267-419) for A patients (n = 251). No significant differences were found between the three groups with regard to age, sex, renal function, or CHA2DS2-VASc score. For all bleeding events the incidence rates per 100 patient-years of follow-up (95% confidence interval [CI], p-value) were reported more often for treatment with R (17.2, 12.7-22.8) than for D (7.0, 4.0-11.3, p = 0.001) and A (8.7, 5.2-13.6, p = 0.013). The differences remained significant after adjustment for clinically relevant variables. Discontinuation rates (n = 167) were lower for A (11.5, 7.5-16.8) than for D (30, 23.4-37.9, p < 0.001) and R (23.9, 18.6-30.1, p = 0.001), and were mainly attributed to drug-specific side effects and bleedings. The majority of discontinued patients (n = 142, 85%) proceeded with other types of oral anticoagulants.
  
  
  CONCLUSIONS
  The main limitation of the study is the small patient population with a short follow-up time.
  
  
  CONCLUSIONS
  In a retrospective study at a single AF clinic, NOACs showed significantly different bleeding rates and varied discontinuation rates when compared to each other, related mainly to agent-specific side effects and bleedings. The majority of patients that discontinued proceeded with other types of oral anticoagulant.
authors.affiliation: a Stockholm Heart Center , Stockholm , Sweden ;|b Department of Clinical Sciences, Karolinska Institutet , Danderyd Hospital , Stockholm , Sweden ;
authors.forename: Faris
authors.initials: F
authors.lastname: Al-Khalili
authors.affiliation: a Stockholm Heart Center , Stockholm , Sweden ;
authors.forename: Catrine
authors.initials: C
authors.lastname: Lindström
authors.affiliation: c Department of Clinical Science and Education, SÖS , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Lina
authors.initials: L
authors.lastname: Benson
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D002318:Cardiovascular Diseases / Q000188:drug therapy; D000069604:Dabigatran / Q000008:administration & dosage; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011720:Pyrazoles / Q000008:administration & dosage; D011728:Pyridones / Q000008:administration & dosage; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000008:administration & dosage; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D014812:Vitamin K / Q000737:chemistry
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Apixaban; atrial fibrillation; dabigatran; persistence; rivaroxaban; safety