Switching to Another Oral Anticoagulant and Drug Discontinuation Among Elderly Patients With Nonvalvular Atrial Fibrillation Treated With Different Direct Oral Anticoagulants

• Published in: Clinical and applied thrombosis/hemostasis Vol. 25; p. 1076029619870249
• Main Authors: Baker, Christine L., Dhamane, Amol D., Rajpura, Jigar, Mardekian, Jack, Dina, Oluwaseyi, Russ, Cristina, Rosenblatt, Lisa, Lingohr-Smith, Melissa, Lin, Jay
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2019; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Administration, Oral; Age; Aged; Aged, 80 and over; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Antithrombins - therapeutic use; Atrial Fibrillation - drug therapy; Cardiac arrhythmia; Dabigatran - therapeutic use; Drug Substitution - statistics & numerical data; Factor Xa Inhibitors - therapeutic use; Female; Humans; Male; Original; Pyrazoles - therapeutic use; Pyridones - therapeutic use; Retrospective Studies; Rivaroxaban - therapeutic use; direct oral anticoagulants; drug switching; dabigatran; rivaroxaban; apixaban; drug discontinuation; nonvalvular atrial fibrillation
• ISSN: 1076-0296; 1938-2723
• DOI: 10.1177/1076029619870249

We compared the risks of switching to another oral anticoagulant (OAC) and discontinuation of direct oral anticoagulants (DOACs) among elderly patients with nonvalvular atrial fibrillation (NVAF) who were prescribed rivaroxaban or dabigatran versus apixaban. Patients (≥65 years of age) with NVAF prescribed DOACs (January 1, 2013 to September 30, 2017) were identified from the Humana research database and grouped into DOAC cohorts. Cox regression analyses were used to evaluate whether the risk for switching to another OAC or discontinuing index DOACs differed among cohorts. Of the study population (N = 38 250), 55.9% were prescribed apixaban (mean age: 78.6 years; 49.8% female), 37.3% rivaroxaban (mean age: 77.4 years; 46.7% female), and 6.8% dabigatran (mean age: 77.0 years; 44.0% female). Compared to patients prescribed apixaban, patients prescribed rivaroxaban (hazard ratio [HR]: 2.08; 95% confidence interval [CI], 1.92-2.25; P < .001) or dabigatran (HR: 3.74; 95% CI, 3.35-4.18, P < .001) had a significantly higher risk of switching to another OAC during the follow-up; compared to patients prescribed apixaban, the risks of discontinuation were also higher for patients treated with rivaroxaban (HR: 1.10; 95% CI, 1.07-1.13, P < .001) or dabigatran (HR: 1.29; 95% CI, 1.23-1.35, P < .001).