Dabigatran Therapy at 2 Years for Atrial Fibrillation

Study Questions:

In patients with atrial fibrillation (AF) who are anticoagulated with dabigatran, how often are the patients still taking the dabigatran 2 years later?

Methods:

The subjects of this study were 2,932 patients (mean age 70.3 years) who were enrolled in an international AF registry and who were anticoagulated with dabigatran. The patients were followed for 2 years.

Results:

The percentage of patients still taking dabigatran was 76.6% at 1 year and 69.2% at 2 years. Overall, 14.9% of patients discontinued treatment with dabigatran and remained anticoagulated and 13.3% were treated with another anticoagulant after discontinuing treatment with dabigatran. In 59.8% of patients who discontinued treatment with dabigatran, the reason was not specified. Eight percent stopped taking dabigatran because of dyspepsia, 7.7% because of a serious adverse event, 7% because of a bleeding event, and 2.3% because of cost. The strongest predictors of discontinuation of dabigatran were location in North America (hazard ratio [HR], 1.53), prior stroke (HR, 0.66), and permanent as opposed to paroxysmal or persistent AF (HR, 0.66).

Conclusions:

Approximately 70% of AF patients who are anticoagulated with dabigatran are still taking it 2 years later.

Perspective:

The 30% discontinuation rate with dabigatran compares favorably with the discontinuation rates of approximately 25-60% reported for warfarin. This is not surprising given the inconveniences associated with the use of warfarin. Unfortunately, the reason for discontinuation was unknown in 59.8% of patients. Therefore, it is not clear how often dabigatran treatment was discontinued because it was thought that anticoagulation was no longer needed, not because of side effects or an adverse event.


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