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Persistence With Dabigatran Therapy at 2 Years in Patients With Atrial Fibrillation
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2017-09-01 , DOI: 10.1016/j.jacc.2017.07.793
Miney Paquette , Lionel Riou França , Christine Teutsch , Hans-Christoph Diener , Shihai Lu , Sergio J. Dubner , Chang Sheng Ma , Kenneth J. Rothman , Kristina Zint , Jonathan L. Halperin , Menno V. Huisman , Gregory Y.H. Lip , Robby Nieuwlaat

BACKGROUND Guidelines recommend long-term oral anticoagulation therapy for stroke prevention in patients with atrial fibrillation (AF). Treatment discontinuation rates in vitamin K antagonist (VKA)-treated patients are high but may be lower with non-VKA oral anticoagulant agents. OBJECTIVES The goal of this study was to describe and explore predictors of dabigatran etexilate persistence in patients with newly diagnosed AF over 2 years of follow-up. METHODS Consecutive patients newly diagnosed with AF and ≥1 stroke risk factor were followed up for 2 years. Dabigatran nonpersistence was defined as discontinuation of dabigatran for >30 days. A multivariable Cox regression model included region as well as patient clinical and sociodemographic characteristics to explore predictors of nonpersistence. RESULTS Eligible patients (N = 2,932) took ≥1 dabigatran dose; their mean age was 70.3 ± 10.2 years, and 55.3% were male. The 2-year probability of dabigatran persistence was 69.2%. Approximately 7% switched to a factor Xa inhibitor and 6% to a VKA. Approximately one-third of dabigatran discontinuations were primarily due to serious or nonserious adverse events. Patients from North America had the highest discontinuation risk, and Latin America had the lowest. Minimally symptomatic or asymptomatic AF and permanent AF were associated with a lower risk for dabigatran nonpersistence. Previous proton pump inhibitor use was associated with a higher risk for dabigatran nonpersistence. CONCLUSIONS Probability of treatment persistence with dabigatran after 2 years was approximately 70%. Nearly one-half of the patients who stopped dabigatran switched to another oral anticoagulant agent. Patients from North America, and those with paroxysmal, persistent, or symptomatic AF, may be at a higher risk for discontinuing dabigatran.

中文翻译:

房颤患者持续使用达比加群治疗 2 年

背景指南推荐长期口服抗凝治疗预防房颤(AF)患者的卒中。维生素 K 拮抗剂 (VKA) 治疗患者的治疗中断率很高,但非 VKA 口服抗凝剂的治疗中断率可能较低。目的 本研究的目的是描述和探索达比加群酯在新诊断 AF 患者中持续 2 年随访的预测因素。方法对新诊断为房颤且卒中危险因素≥1的连续患者随访2年。达比加群不持续被定义为达比加群停药>30 天。多变量 Cox 回归模型包括区域以及患者的临床和社会人口学特征,以探索非持久性的预测因素。结果 符合条件的患者(N = 2,932) 服用≥1 剂达比加群;他们的平均年龄为 70.3 ± 10.2 岁,55.3% 是男性。达比加群持续 2 年的概率为 69.2%。大约 7% 的患者改用 Xa 因子抑制剂,6% 改用 VKA。大约三分之一的达比加群停药主要是由于严重或非严重的不良事件。北美患者的停药风险最高,拉丁美洲的患者最低。轻微症状或无症状 AF 和永久性 AF 与达比加群非持久性的风险较低相关。以前使用质子泵抑制剂与达比加群非持久性的风险较高有关。结论 2 年后达比加群持续治疗的概率约为 70%。近一半停止达比加群的患者改用另一种口服抗凝剂。
更新日期:2017-09-01
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