Switching from vitamin K antagonists to direct oral anticoagulants in non-valvular atrial fibrillation patients: Does low time in therapeutic range affect persistence?

Myrthe M.A. Toorop, Qingui Chen, Marieke J.H.A. Kruip, Felix J.M. van der Meer, Melchior C. Nierman, Laura Faber, Lies Goede, Suzanne C. Cannegieter*, Willem M. Lijfering

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: Non-valvular atrial fibrillation (NVAF) patients are advised to switch from a vitamin K antagonist (VKA) to direct oral anticoagulant (DOAC) when time in therapeutic range (TTR) is low. Objective: To examine if pre-switch TTR determines persistence patterns in NVAF patients who are switched from a VKA to DOAC. Patients/Methods: Adult NVAF patients from three Dutch anticoagulation clinics who were newly switched from a VKA to DOAC between July 1, 2013 and September 30, 2018 were stratified by pre-switch TTR levels. DOAC prescription records were examined to determine persistence patterns according to a 100-day prescription gap. Cumulative incidences of non-persistence to DOAC were estimated using the cumulative incidence competing risk method. The association of pre-switch TTR levels with DOAC non-persistence was evaluated by Cox regression models. Results: A total of 3696 NVAF patients were included, of whom 690 (18.7%) had a pre-switch TTR ≤ 45%. After switching from VKA to DOAC, 14.0% (95% confidence interval [CI] 11.3–17.0%) of the patients with a pre-switch TTR ≤ 45% became non-persistent to DOAC within 1 year, while 9.8% (95% CI 8.7–11.0%) did in those with a pre-switch TTR > 45%. In a multivariable model, a pre-switch TTR ≤ 45% was associated with a higher risk of non-persistence to DOAC (adjusted hazard ratio 1.55, 95% CI 1.22–1.97). Results were similar when using other cut-off points (60% or 70%) to define a low TTR. Conclusion: NVAF patients switching from VKA to DOAC due to a low pre-switch TTR saw a worse persistence pattern to DOAC after the switch compared to patients with a high pre-switch TTR.

Original languageEnglish
Pages (from-to)339-352
Number of pages14
JournalJournal of Thrombosis and Haemostasis
Volume20
Issue number2
Early online date14 Nov 2021
DOIs
Publication statusPublished - Feb 2022

Bibliographical note

Funding Information:
Results are based on calculations by the authors using non‐public microdata made available by Statistics Netherlands. The authors thank Statistics Netherlands for making data from the Dutch Hospital Data registry available. Qingui Chen is supported by the Chinese Government Scholarship (No. 201906380148) for his PhD study in the Leiden University Medical Center. The authors thank the Federation of Dutch Thrombosis Services for making data available.

Publisher Copyright:
© 2021 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.

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