title: Real-world persistence and adherence to oral anticoagulation for stroke risk reduction in patients with atrial fibrillation.
abstract: OBJECTIVE
  To assess persistence and adherence to rivaroxaban, dabigatran, and vitamin K antagonist (VKA) treatment in primary care patients with non-valvular atrial fibrillation (AF) newly starting anticoagulant therapy.
  
  
  RESULTS
  Prescription data for oral anticoagulants were obtained from 7265 eligible patients from primary care practices across Germany. Persistence with and adherence to anticoagulation were assessed in anticoagulant-naïve patients with AF newly treated with dabigatran, rivaroxaban, or VKA during follow-up periods of at least 180 days, respectively 360 days after the prescription date. Persistence probabilities after 180 days were 66.0% for rivaroxaban, 60.3% for dabigatran, and 58.1% for VKA (P < 0.001 for rivaroxaban vs. VKA and P = 0.008 for rivaroxaban vs. dabigatran). After 360 days, persistence probabilities were 53.1, 47.3, and 25.5%, respectively (P < 0.001 for rivaroxaban and dabigatran vs. VKA). Considering the development over 360 days rivaroxaban demonstrated a better persistence compared with dabigatran (P = 0.026). Male gender and the presence of diabetes mellitus were associated with increased persistence, while renal impairment and antiplatelet drug use decreased persistence. High adherence (MPR ≥0.80) was observed in 61.4% of rivaroxaban users and in 49.5% of dabigatran users, with means of 0.76 [95% confidence interval (CI) 0.74-0.78] for rivaroxaban and 0.67 (95% CI 0.65-0.69) for dabigatran (P < 0.001).
  
  
  CONCLUSIONS
  Rivaroxaban and dabigatran demonstrated better persistence than VKA at Day 360. Furthermore, rivaroxaban was associated with better persistence and adherence than dabigatran. Further studies are needed to identify factors responsible for this difference and evaluate the impact on outcomes.
authors.affiliation: Center for Vascular Medicine, University Hospital "Carl Gustav Carus"; Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany jan.beyer@uniklinikum-dresden.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Beyer-Westendorf
authors.affiliation: IMS Health, Munich, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Ehlken
authors.affiliation: Bayer Pharma AG, Wuppertal, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Evers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001777:Blood Coagulation; D000069604:Dabigatran / Q000008:administration & dosage* / Q000009:adverse effects; D016208:Databases, Factual; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D000069552:Rivaroxaban / Q000008:administration & dosage* / Q000009:adverse effects; D020521:Stroke / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D016903:Drug Monitoring
chemical_list: D065427:Factor Xa Inhibitors; D014812:Vitamin K; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Dabigatran; Oral anticoagulation; Primary care; Real world; Rivaroxaban; Vitamin K antagonist