title: Permanent discontinuation of non vitamin K oral anticoagulants in real life patients with non-valvular atrial fibrillation.
abstract: BACKGROUND
  Persistence to treatment affects clinical outcomes in patients with chronic disease such as atrial fibrillation (AF).
  
  
  METHODS
  This prospective cohort study included consecutive non-valvular AF patients prescribed with non-vitamin K oral anticoagulants (NOACs) and investigated for any permanent discontinuation at 1-year of this therapy, as well as any reasons for discontinuation.
  
  
  RESULTS
  Overall, 1305 patients were prescribed with dabigatran (N=473), rivaroxaban (N=425) or apixaban (N=407). Of these, 201 patients (15.4%) discontinued NOACs during the first year of treatment. More than 60% of these discontinuations occurred during the first 6months. Reasons for discontinuation included: dyspepsia or abdominal pain in 38 patients (2.9%) and bleeding in 59 (4.5%). Discontinuation for the former occurred earlier (50% within 2months) compared to the latter (66% after the first 4months). The prescription of reduced NOAC doses resulted being an independent predictor of discontinuation (OR 1.74, 95% CI 1.23-2.45, p=0.002). Regarding the use of dabigatran, rivaroxaban and apixaban, the following were observed: discontinuers were 22.0% (95% CI 18.5-25.9), 14.4% (95% CI 11.3-18.0) and 8.8% (95% CI 6.5-12.0), the risk of discontinuation associated with bleeding was 20.2%, 44.3% and 30.6% and dyspepsia or abdominal pain was 35.6%, 1.6% and 0%, respectively.
  
  
  CONCLUSIONS
  Discontinuation of NOACs in AF patients was relatively common and more than often occurred in the first six months after prescription. Patients treated with reduced doses of NOACs had a higher probability to discontinue compared to those who were prescribed conventional doses.
authors.affiliation: Internal, Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy. Electronic address: mc.vedovati@gmail.com.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vedovati
authors.affiliation: Department of Medicine, Hospital of Assisi, Assisi, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.affiliation: Internal, Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Giustozzi
authors.affiliation: Department of Medicine, Hospital of Assisi, Assisi, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Molini
authors.affiliation: Division of Cardiology, S. Matteo degli Infermi Hospital, Spoleto, Italy.
authors.forename: Serenella
authors.initials: S
authors.lastname: Conti
authors.affiliation: Emergency Medicine, S. Maria Delle Croci Hospital, Ravenna, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Pierpaoli
authors.affiliation: Department of Medicine, Hospital of Assisi, Assisi, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Valecchi
authors.affiliation: Department of Medicine, Hospital of Assisi, Assisi, Italy.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Aita
authors.affiliation: Internal, Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.affiliation: Internal, Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology*; D015331:Cohort Studies; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects; D004415:Dyspepsia / Q000139:chemically induced; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Anticoagulants; Apixaban; Atrial fibrillation; Dabigatran; Discontinuation; Rivaroxaban