Impact of medication adherence on risk of ischemic stroke, major bleeding and deep vein thrombosis in atrial fibrillation patients using novel oral anticoagulants

AbstractObjectives: Our study examined the impact of adherence to novel oral anticoagulants [NOACs - dabigatran and rivaroxaban] on ischemic-stroke (IS), major-bleeding (MB), deep-vein-thrombosis and pulmonary-embolism (DVTPE) risk in a large, nationwide, propensity-matched sample.Methods: A retrospective cohort study utilized data from a US commercial managed-care database (2010–2012). Adult patients with ≥1 diagnosis of atrial fibrillation/flutter (ICD-9 427.31/32), >1 prescription of NOACs and CHA2DS2-VASc score ≥1 were included. Patients were categorized as adherent versus nonadherent (using proportion of days covered [PDC ≥80%]) based on their NOAC use up to 6 months and those continued its use up to 12 months. The patients were matched using propensity score (based on inverse probability treatment weighting) and the risk of IS, MB, DVTPE outcomes was evaluated for the matched cohorts’ post-adherence (exposure) assessment using multivariable Cox regression.Results: A total of 3,629 and 1,946 patients...