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Drug Utilization Pattern of Oral Anticoagulants in Patients with Atrial Fibrillation: A Nationwide Population-Based Study in Korea

Authors
Lee, Myung-YongHan, SolaBang, Oh YoungOn, Young KeunJang, Sung-WonHan, SeongwookRyu, JaeyunPark, Yoo-JungKang, SeongsikSuh, Hae SunKim, Young-Hoon
Issue Date
Jul-2022
Publisher
Health Communications, Inc.
Keywords
Anticoagulants; Atrial fibrillation; Medication adherence; Stroke; Treatment pattern
Citation
Advances in Therapy, v.39, no.7, pp.3112 - 3130
Indexed
SCIE
SCOPUS
Journal Title
Advances in Therapy
Volume
39
Number
7
Start Page
3112
End Page
3130
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/60899
DOI
10.1007/s12325-022-02151-z
ISSN
0741-238X
Abstract
Introduction Treatment persistence for anticoagulant therapy is important in preventing thromboembolism in nonvalvular atrial fibrillation (NVAF) patients. Understanding drug utilization pattern and treatment changes in oral anticoagulant (OAC) users may facilite better NVAF management. Thus, our study aimed to examine OAC treatment patterns preceding events leading to switch or discontinuation and medication adherence in Korean NVAF patients. Methods We conducted a drug utilization study on all Korean patients with atrial fibrillation (AF) newly prescribed OACs between July 2015 and November 2016 using the national claims data. We assessed treatment changes such as switching and discontinuation from index OAC and relevant events preceding the change and examined patient characteristics as predictors of changes that occurred among OAC users. Medication adherence was compared among OAC users by calculating the medication possession ratio (MPR). Results A total of 48,389 NVAF patients were identified who initiated OACs within the study period. Most initiated nonvitamin K antagonist oral anticoagulants (NOACs) (22% apixaban, 24% dabigatran, 37% rivaroxaban), and 18% initiated warfarin. The frequency of switch to another OAC was 8.8% for apixaban, 16.1% for dabigatran, 6.6% for rivaroxaban, and 19.1% for warfarin. The frequency of discontinuation was lower for apixaban (22.9%), dabigatran (26.3%), and rivaroxaban (25.7%) than warfarin (31.6%). Compared to warfarin, NOAC users were less likely to switch treatment. Thromboembolic event was the most common clinical event preceding switch from warfarin to NOAC and from NOAC to warfarin. Discontinuation of OAC was often preceded by a bleeding event. Patients who initiated apixaban showed significantly higher mean MPR compared to those on dabigatran and warfarin. Conclusion In real-world practice in Korea, we have observed treatment change to be common in OAC users. Our results indicate better medication adherence with NOACs than with warfarin. (ClinicalTrials.gov registration number NCT03572972).
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Kim, Young Hoon
안암병원 (Department of Cardiology, Anam Hospital)
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