Skip to main content
Erschienen in: Heart and Vessels 7/2020

31.01.2020 | Original Article

Persistence, effectiveness and safety of dabigatran in “real-world” Chinese patients with nonvalvular atrial fibrillation

verfasst von: Guodong Rong, Yiling Huang, Lin Wang, Hanyu Liang, Hong Wang

Erschienen in: Heart and Vessels | Ausgabe 7/2020

Einloggen, um Zugang zu erhalten

Abstract

The purpose of this study is to provide detailed data on treatment persistence and clinical outcomes in Chinese patients with nonvalvular atrial fibrillation (NVAF). A single-center retrospective observational study was conducted. A total of 26,663 NVAF patients were enrolled from January 1, 2014 to December 31, 2017, clinical information of whom were from inpatient and outpatients data system was collected. The 1-year treatment persistence rates of 11,350 dabigatran users were 24.5% in 2014, 36.6% in 2015, 37.7% in 2016 and 51.8% in 2017. The predominant reason of non-persistence patients was the cost of treatment. Incidence rates of all-cause death, ischemic stroke and embolism were 1.99/100 person-years, 2.56/100 person-years and 0.77/100 person-years, respectively. Incidence rates of minor bleeding events, intracranial hemorrhage and gastrointestinal hemorrhage were 10.05/100 person-years, 0.51/100 person-years and 0.85/100 person-years, respectively. In conclusion, it is of importance for Chinese clinicians to know about these information because dabigatran is a relatively new drug in China. Compared with other reported data, patients of this study have (1) lower dabigatran persistence and lower incident rates of all-cause death, systemic embolism, minor bleeding events and gastrointestinal hemorrhage and (2) higher incident rates of ischemic stroke and intracranial hemorrhage.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, ESC Committee for Practice Guidelines (CPG) (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33:2719–2747CrossRef Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, ESC Committee for Practice Guidelines (CPG) (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33:2719–2747CrossRef
2.
Zurück zum Zitat Geng YP, Lan DH, Liu N, Du X, Zheng D, Tang RB, Long DY, Yu RH, Sang CH, Bai R, Jiang CX, Li SN, Guo XY, Wang W, Xia SJ, Chang SS, Dong JZ, Chen AH, Ma CS (2018) Patient-reported treatment satisfaction with dabigatran versus warfarin in patients with non-valvular atrial fibrillation in China. Thromb Haemost 118:1815–1822CrossRef Geng YP, Lan DH, Liu N, Du X, Zheng D, Tang RB, Long DY, Yu RH, Sang CH, Bai R, Jiang CX, Li SN, Guo XY, Wang W, Xia SJ, Chang SS, Dong JZ, Chen AH, Ma CS (2018) Patient-reported treatment satisfaction with dabigatran versus warfarin in patients with non-valvular atrial fibrillation in China. Thromb Haemost 118:1815–1822CrossRef
3.
Zurück zum Zitat Cha MJ, Choi EK, Han KD, Lee SR, Lim WH, Oh S, Lip GYH (2017) Effectiveness and safety of non-vitamin K antagonist oral anticoagulants in asian patients with atrial fibrillation. Stroke 48:3040–3048CrossRef Cha MJ, Choi EK, Han KD, Lee SR, Lim WH, Oh S, Lip GYH (2017) Effectiveness and safety of non-vitamin K antagonist oral anticoagulants in asian patients with atrial fibrillation. Stroke 48:3040–3048CrossRef
4.
Zurück zum Zitat Ho CW, Ho MH, Chan PH, Hai JJ, Cheung E, Yeung CY, Lau KK, Chan KH, Lau CP, Lip GY, Leung GK, Tse HF, Siu CW (2015) Ischemic stroke and intracranial hemorrhage with aspirin, dabigatran, and warfarin: impact of quality of anticoagulation control. Stroke 46:23–30CrossRef Ho CW, Ho MH, Chan PH, Hai JJ, Cheung E, Yeung CY, Lau KK, Chan KH, Lau CP, Lip GY, Leung GK, Tse HF, Siu CW (2015) Ischemic stroke and intracranial hemorrhage with aspirin, dabigatran, and warfarin: impact of quality of anticoagulation control. Stroke 46:23–30CrossRef
5.
Zurück zum Zitat Li WH, Huang D, Chiang CE, Lau CP, Tse HF, Chan EW, Wong ICK, Lip GYH, Chan PH, Siu CW (2017) Efficacy and safety of dabigatran, rivaroxaban, and warfarin for stroke prevention in Chinese patients with atrial fibrillation: the Hong Kong Atrial Fibrillation Project. Clin Cardiol 40:222–229CrossRef Li WH, Huang D, Chiang CE, Lau CP, Tse HF, Chan EW, Wong ICK, Lip GYH, Chan PH, Siu CW (2017) Efficacy and safety of dabigatran, rivaroxaban, and warfarin for stroke prevention in Chinese patients with atrial fibrillation: the Hong Kong Atrial Fibrillation Project. Clin Cardiol 40:222–229CrossRef
6.
Zurück zum Zitat Wang H, Zhou Y, Rong G, Lu L, Zhang J (2016) A novel coagulation parameter monitoring bleeding tendency of Chinese nonvalvular atrial fibrillation patients prescribing dabigatran etexilate. Blood Coagul Fibrinolysis 27:563–567CrossRef Wang H, Zhou Y, Rong G, Lu L, Zhang J (2016) A novel coagulation parameter monitoring bleeding tendency of Chinese nonvalvular atrial fibrillation patients prescribing dabigatran etexilate. Blood Coagul Fibrinolysis 27:563–567CrossRef
7.
Zurück zum Zitat Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific, and Standardization Committee of the International Society on Thrombosis Haemostasis (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in nonsurgical patients. J Thromb Haemost 3:692–694CrossRef Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific, and Standardization Committee of the International Society on Thrombosis Haemostasis (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in nonsurgical patients. J Thromb Haemost 3:692–694CrossRef
8.
Zurück zum Zitat Hylek EM (2018) Treatment persistence in atrial fibrillation: the next major hurdle. Thromb Haemost 118:2018–2019CrossRef Hylek EM (2018) Treatment persistence in atrial fibrillation: the next major hurdle. Thromb Haemost 118:2018–2019CrossRef
9.
Zurück zum Zitat Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L, RE-LY Steering Committee Investigators (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151CrossRef Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L, RE-LY Steering Committee Investigators (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151CrossRef
10.
Zurück zum Zitat Collings SL, Lefèvre C, Johnson ME, Evans D, Hack G, Stynes G, Maguire A (2017) Oral anticoagulant persistence in patients with non-valvular atrial fibrillation: a cohort study using primary care data in Germany. PLoS ONE 12:e0185642CrossRef Collings SL, Lefèvre C, Johnson ME, Evans D, Hack G, Stynes G, Maguire A (2017) Oral anticoagulant persistence in patients with non-valvular atrial fibrillation: a cohort study using primary care data in Germany. PLoS ONE 12:e0185642CrossRef
11.
Zurück zum Zitat Jackson LR II, Kim S, Shrader P, Blanco R, Thomas L, Ezekowitz MD, Ansell J, Fonarow GC, Gersh BJ, Go AS, Kowey PR, Mahaffey KW, Hylek EM, Peterson ED, Piccini JP Sr (2018) Early therapeutic persistence on dabigatran versus warfarin therapy in patients with atrial fibrillation: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry. J Thromb Thrombolysis 46:435–439CrossRef Jackson LR II, Kim S, Shrader P, Blanco R, Thomas L, Ezekowitz MD, Ansell J, Fonarow GC, Gersh BJ, Go AS, Kowey PR, Mahaffey KW, Hylek EM, Peterson ED, Piccini JP Sr (2018) Early therapeutic persistence on dabigatran versus warfarin therapy in patients with atrial fibrillation: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry. J Thromb Thrombolysis 46:435–439CrossRef
12.
Zurück zum Zitat Harper P, Pollock D, Stephens M (2018) Dabigatran persistence and adherence in New Zealand: a nationwide retrospective observational study. BMJ Open 8:e020212CrossRef Harper P, Pollock D, Stephens M (2018) Dabigatran persistence and adherence in New Zealand: a nationwide retrospective observational study. BMJ Open 8:e020212CrossRef
13.
Zurück zum Zitat Vedovati MC, Verdecchia P, Giustozzi M, Molini G, Conti S, Pierpaoli L, Valecchi F, Aita A, Agnelli G, Becattini C (2017) Permanent discontinuation of non-vitamin K oral anticoagulants in real life patients with non-valvular atrial fibrillation. Int J Cardiol 236:363–369CrossRef Vedovati MC, Verdecchia P, Giustozzi M, Molini G, Conti S, Pierpaoli L, Valecchi F, Aita A, Agnelli G, Becattini C (2017) Permanent discontinuation of non-vitamin K oral anticoagulants in real life patients with non-valvular atrial fibrillation. Int J Cardiol 236:363–369CrossRef
14.
Zurück zum Zitat Jackevicius CA, Tsadok MA, Essebag V, Atzema C, Eisenberg MJ, Tu JV, Lu L, Rahme E, Ho PM, Turakhia M, Humphries KH, Behlouli H, Zhou L, Pilote L (2017) Early non-persistence with dabigatran and rivaroxaban in patients with atrial fibrillation. Heart 103:1331–1338CrossRef Jackevicius CA, Tsadok MA, Essebag V, Atzema C, Eisenberg MJ, Tu JV, Lu L, Rahme E, Ho PM, Turakhia M, Humphries KH, Behlouli H, Zhou L, Pilote L (2017) Early non-persistence with dabigatran and rivaroxaban in patients with atrial fibrillation. Heart 103:1331–1338CrossRef
15.
Zurück zum Zitat Mueller T, Alvarez-Madrazo S, Robertson C, Bennie M (2017) Use of direct oral anticoagulants in patients with atrial fibrillation in Scotland: Applying a coherent framework to drug utilisation studies. Pharmacoepidemiol Drug Saf 26:1378–1386CrossRef Mueller T, Alvarez-Madrazo S, Robertson C, Bennie M (2017) Use of direct oral anticoagulants in patients with atrial fibrillation in Scotland: Applying a coherent framework to drug utilisation studies. Pharmacoepidemiol Drug Saf 26:1378–1386CrossRef
16.
Zurück zum Zitat Lamberts M, Staerk L, Olesen JB, Fosbøl EL, Hansen ML, Harboe L, Lefevre C, Evans D, Gislason GH (2017) Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: contemporary findings in real-life Danish patients. J Am Heart Assoc 6:e004517CrossRef Lamberts M, Staerk L, Olesen JB, Fosbøl EL, Hansen ML, Harboe L, Lefevre C, Evans D, Gislason GH (2017) Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: contemporary findings in real-life Danish patients. J Am Heart Assoc 6:e004517CrossRef
17.
Zurück zum Zitat Paquette M, Riou França L, Teutsch C, Diener HC, Lu S, Dubner SJ, Ma CS, Rothman KJ, Zint K, Halperin JL, Huisman MV, Lip GYH, Nieuwlaat R (2017) Persistence with dabigatran therapy at 2 years in patients with atrial fibrillation. J Am Coll Cardiol 70:1573–1583CrossRef Paquette M, Riou França L, Teutsch C, Diener HC, Lu S, Dubner SJ, Ma CS, Rothman KJ, Zint K, Halperin JL, Huisman MV, Lip GYH, Nieuwlaat R (2017) Persistence with dabigatran therapy at 2 years in patients with atrial fibrillation. J Am Coll Cardiol 70:1573–1583CrossRef
18.
Zurück zum Zitat Maura G, Billionnet C, Alla F, Gagne JJ, Pariente A (2018) Comparison of treatment persistence with dabigatran or rivaroxaban versus vitamin k antagonist oral anticoagulants in atrial fibrillation patients: a competing risk analysis in the french national health care databases. Pharmacotherapy 38:6–18CrossRef Maura G, Billionnet C, Alla F, Gagne JJ, Pariente A (2018) Comparison of treatment persistence with dabigatran or rivaroxaban versus vitamin k antagonist oral anticoagulants in atrial fibrillation patients: a competing risk analysis in the french national health care databases. Pharmacotherapy 38:6–18CrossRef
19.
Zurück zum Zitat Meng SW, Lin TT, Liao MT, Chen HM, Lai CL (2019) Direct comparison of low-dose dabigatran and rivaroxaban for effectiveness and safety in patients with non-valvular atrial fibrillation. Acta Cardiol Sin 35:42–54PubMedPubMedCentral Meng SW, Lin TT, Liao MT, Chen HM, Lai CL (2019) Direct comparison of low-dose dabigatran and rivaroxaban for effectiveness and safety in patients with non-valvular atrial fibrillation. Acta Cardiol Sin 35:42–54PubMedPubMedCentral
Metadaten
Titel
Persistence, effectiveness and safety of dabigatran in “real-world” Chinese patients with nonvalvular atrial fibrillation
verfasst von
Guodong Rong
Yiling Huang
Lin Wang
Hanyu Liang
Hong Wang
Publikationsdatum
31.01.2020
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 7/2020
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-020-01565-5

Weitere Artikel der Ausgabe 7/2020

Heart and Vessels 7/2020 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.