Discontinuation of NOACs in patients with NVAF in the UK

What is it about?

Owing to the short half-life of NOACs, their use should be uninterrupted to maintain the drug in the therapeutic range and thereby providing adequate thromboembolic protection. Since the introduction of NOACs in clinical practice, many studies have evaluated patient discontinuation rates; however, several have been limited in size and follow-up duration and/or restricted to only one or two individual NOACs. We conducted a large population-based cohort study to evaluate the frequency and predictors of discontinuation of NOACs among first-time NOAC users with non-valvular atrial fibrillation (NVAF), as well as subsequent detailed patterns of OAC therapy use during the first year of treatment in the UK between January 2012 and December 2016.

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Why is it important?

One year discontinuation rates according to the index NOAC were 26.1% for apixaban, 40.0% for dabigatran and 29.6% for rivaroxaban. Reinitiation rates were 18.1% for apixaban, 21.7% for dabigatran and 17.3% for rivaroxaban, and switching rates were 2.8% for apixaban, 8.8% for dabigatran and 4.9% for rivaroxaban. More than 93% of reinitiations were with the index NOAC. Patients starting on dabigatran were more likely to switch OAC therapy than those starting on apixaban; ORs 4.28 (95% CI 3.24 to 5.65) for dabigatran and 1.89 (95% CI 1.49 to 2.39) for rivaroxaban. Severely reduced renal function was a predictor of any discontinuation, OR 1.77 (95% CI 1.28 to 2.44).

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