However, reasons for non-persistence could also highlight problems with tolerability and effectiveness of a drug

However, reasons for non-persistence could also highlight problems with tolerability and effectiveness of a drug. thromboembolism 14.1%; hypertension 84.3%) and high bleeding risk (HAS-BLED score3 68.4%) was common. Apixaban-prescribed patients had more frequent history of stroke/TIA (19.7%) and high bleeding risk (72.6%) than other OACs. 12-month persistence rates were: VKA 57.5% (95% confidence interval (CI) 56.0C59.0%), rivaroxaban 56.6% (54.9C58.2%), dabigatran 50.1% (47.2C53.1%), apixaban 62.9% (58.8C67.0%). Over entire follow-up, compared to VKA, non-persistence was similar with apixaban (adjusted hazard ratio 1.08, 95% CI 0.95C1.24) but higher with rivaroxaban (1.21, 1.14C1.29) and dabigatran (1.53, 1.40C1.68). GAP-134 (Danegaptide) Using post-hoc time-partitioned approach: in first 100 days, non-persistence was higher with apixaban (1.37, 1.17C1.59), rivaroxaban (1.41, 1.30C1.53) and dabigatran (1.91, 1.70C2.14) compared to VKA. Compared to apixaban, rivaroxaban non-persistence was similar (1.03, 0.89C1.20), dabigatran was higher (1.39, 1.17C1.66). After 100 days, apixaban non-persistence was lower than VKA (0.66, 0.52C0.85); rivaroxaban (0.97, 0.87C1.07) and dabigatran (1.10, 0.95C1.28) were similar to VKA. Furthermore, rivaroxaban (1.46, 1.13C1.88) and dabigatran (1.67, 1.26C2.19) non-persistence was higher than apixaban. This study describes real-world observations on OAC use, particularly early apixaban use following approval for NVAF, in Germany. We identified potential differential OAC prescribing and higher persistence with apixaban than other OACs after 100 days treatment. Larger studies are needed with MYH9 longer follow-up to establish long-term patterns. Introduction Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia [1], with an estimated global burden of over 30 million people [2] and an increasing prevalence over time [3]. While anti-arrhythmic drugs can be prescribed to treat the irregular heart beat patterns that characterise AF, it is a condition which carries an increased likelihood of different sequelae [4]. In particular, there is an elevated risk of ischaemic stroke in patients with AF [5], for which long-term treatment with oral anticoagulants (OACs) is recommended to prevent stroke [6C9]. Traditionally, vitamin K antagonists (VKAs) have been the preferred OAC; however, VKAs have a narrow therapeutic window, require close monitoring and come with substantial dietary restrictions [10]. These limitations may explain the GAP-134 (Danegaptide) poor persistence rates documented with over a quarter of users stopping VKAs within a year of initiation [11,12]. In recent years, the novel OACs (NOACs) dabigatran, rivaroxaban, apixaban and edoxaban have become available. While clinical trials have shown the NOACs to have at least equal efficacy to GAP-134 (Danegaptide) VKA [6C8,13], the NOACs are designed to be simpler to use in that they do not require the patient GAP-134 (Danegaptide) to be monitored or control their diet [14,15]. Moreover, there is evidence that subsequent bleeding eventsCone of the major concerns of OAC useCare less frequent with apixaban, adjusted dose dabigatran and edoxaban than with VKAs in clinical trials [8,13,16]. As patients with AF are at elevated risk of ischaemic stroke when untreated, assessing OAC persistence is crucial to understanding the extent to which patients continuously receive the benefit of stroke prevention while tolerating possible side effects. Research using real-world data is key to observing persistence without the influence of a study environment, such as a clinical trial. However, real-world data studies of new drugs require time for information to naturally accumulate as the drugs become routinely used in clinical practice. At the GAP-134 (Danegaptide) time this study was performed in 2015, apixaban was the most recently approved OAC licensed for stroke prevention in NVAF. With rivaroxaban and dabigatran having also been in circulation for some years, it is now timely to use real-world data to assess OAC treatment persistence. The aim of this study was therefore to describe the characteristics of patients newly prescribed different OACs for stroke prevention and then to estimate and compare persistence rates between OACs using real-world data from German primary care. Methods This was a cohort study of patients with.