Introduction: In the treatment of non-valvular atrial fibrillation (AF) with oral
anticoagulant (OAC), the patients' adherence to therapy is a very important factor
in stroke prevention. Aim: To investigate the one-year persistence of different OAC
therapies (vitamin K antagonist [VKA] and new oral anticoagulants [NOAC]) in patients
with AF. Method: The authors investigated the persistence of oral anticoagulant (OAC
= VKA/NOAC) in atrial fibrillation using the National Health Insurance Fund of Hungary
prescriptions database on pharmacy claims between June 1, 2016 and December 31, 2016.
Results: 122 870 patients met the inclusion criteria. 18 650 patients started OACs
therapy newly (therapy-naïve group), while 104 220 were already on one of the OACs.
Among new patients, the one-year persistence of NOACs was 65.7% and that of VKA was
39.0% (p<0.001). The one-year persistence rate was 72.6% for NOAC and 53.9% for VKA
(p<0.001) in patients already on OACs. In the therapy-naïve group, the one-year persistence
to rivaroxaban was 65.7%. To apixaban it was 62.6%, and to dabigatran it was 59.2%
(logrank p<0.001 in all comparisons except rivaroxaban vs. apixaban: p = 0.017, and
dabigatran vs. apixaban: p<0.01). The one-year persistence rate of patients treated
with NOACs was 73.4% to rivaroxaban, 68.0% to apixaban, and 68.4% to dabigatran (logrank
p<0.001 in all comparisons except apixaban vs. dabigatran, NS). Conclusions: The one-year
persistence of NOACs was significantly higher in AF compared to VKA therapy (in therapy-naïve
and in already treated patients, too). Among the NOACs, rivaroxaban has the best one-year
persistence in all patient populations. Orv Hetil. 2020; 161(20): 839-845.
