BACKGROUND Oral
anticoagulants (OACs) such as
warfarin and non-VKA oral
anticoagulants (NOACs) have been recommended for patients with
atrial fibrillation (AF) who are at risk for
stroke. Whether NOACs have a higher persistence than
warfarin is still unclear. This is especially true in China. MATERIAL AND METHODS Data from a large hospital-based cohort in China (China-AF Registry) from 2011 to 2017 were used for this study. Non-valvular AF patients with newly initiated OACs were included. A time-to-event approach was used to analyze patient persistence. The survival distributions of persistence were compared using the log-rank test. A multivariable Cox regression model was used to explore predictors of
warfarin and NOACs non-persistence. RESULTS Patients with newly initiated
warfarin (n=4845) or NOACs (n=854) were included in this study. Persistence rates at 1, 2, and 3 years were 93.2%, 89.4%, and 87.2% in the
warfarin group and 88.8%, 84.3%, and 81.3% in the
NOAC group respectively. Non-persistence was significantly higher with NOACs than with
warfarin. On multivariate analysis, age <75 years old, outpatient clinic visits, asymptomatic AF, paroxysmal AF, duration of
AF <3 years, history of
peptic ulcer, and no previous TIA,
stroke or
thromboembolism were strong predictors of
warfarin non-persistence, while in the NOACs group, age <75 years old, outpatient clinic visits, lower education status and no history of
congestive heart failure were predictors. CONCLUSIONS Treatment persistence of NOACs was lower than that of
warfarin among Chinese patients with AF. Patients with characteristics of non-persistence predictors need special attention to maintain their
therapy.