title: Oral anticoagulant discontinuation in patients with nonvalvular atrial fibrillation.
abstract: To identify factors associated with all-cause discontinuation (patient discontinued on their own or physician discontinuation) of oral anticoagulants (OACs) among nonvalvular atrial fibrillation (NVAF) patients.
  
  
  
  Retrospective cohort study.
  
  
  
  We analyzed the MarketScan claims database from October 2009 to July 2012. Adult patients were eligible if they newly initiated an OAC in the study period, had an atrial fibrillation diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification code 427.31 or 472.32), and had at least 6 months of continuous enrollment after OAC initiation. Multivariable Cox proportional hazards regression was used to assess factors associated with discontinuation. Adjusted hazard ratios (HRs) and 95% CIs were reported.
  
  
  
  Among 12,129 eligible patients, 8143 (67.1%) initiated warfarin and 3986 (32.9%) initiated direct oral anticoagulants (DOACs). Overall, 47.3% of patients independently discontinued during follow-up (mean number of days of follow-up = 416.6 [SD ± 141.7]) with mean time to discontinuation of 120 days (SD ± 114.7). Patients significantly less likely to discontinue included those taking DOACs versus warfarin (HR, 0.91; 95% CI, 0.86-0.97), older patients (≥65 years vs 18 to 34 years) (HR, 0.32; 95% CI, 0.24-0.43), those with diabetes (HR, 0.84; 95% CI, 0.77-0.90), those with prior stroke/transient ischemic attack (HR, 0.65; 95% CI, 0.56-0.75), those with prior pulmonary embolism (HR, 0.71; 95% CI, 0.58-0.88), and those with congestive heart failure (HR, 0.80; 95% CI, 0.74-0.87). Patients with prior bleeding events were significantly more likely to independently discontinue (HR, 1.20; 95% CI, 1.08-1.34).
  
  
  
  The risk of independent discontinuation of OAC treatment among NVAF patients was high. Patients on DOACs compared with warfarin and those with several comorbid conditions had significantly lower risk of discontinuation, while those with prior bleeding were more likely to discontinue.
authors.forename: Sumesh
authors.initials: S
authors.lastname: Kachroo
authors.forename: Melissa
authors.initials: M
authors.lastname: Hamilton
authors.forename: Xianchen
authors.initials: X
authors.lastname: Liu
authors.forename: Xianying
authors.initials: X
authors.lastname: Pan
authors.forename: Diana
authors.initials: D
authors.lastname: Brixner
authors.forename: Nassir
authors.initials: N
authors.lastname: Marrouche
authors.affiliation: University of Utah College of Pharmacy, L.S. Skaggs Pharmacy Institute, 30 South 2000 East, Rm 4962, Salt Lake City, UT 84112. E-mail: joe.biskupiak@utah.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Biskupiak
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control; D014481:United States / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin