Abstract:

Objective To investigate adherence and associated factors of non-vitamin K antagonist oral anticoagulants(NOACs) therapy,as well as reasons of discontinuance in patients with non-valvular atrial fibrillation(NVAF).Methods By convenience sampling,133 patients with NVAF on NOACs therapy from March 2016 to March 2018 were followed up to collect data about duration of anticoagulation,reasons for cessation and adverse events. Kaplan-Meier and Cox regression were used to explore adherence of NOACs and associated factors.Results One hundred and one(75.9%)and 32(24.1%) patients took dabigratran and rivaroxaban,respectively. The duration of anticoagulation in patients was 182 days. The duration time in patients taking dabigratran and rivaroxaban were 182 and 305 days,respectively. Survival table showed that the cumulative proportion of patients still taking the medicine at 3 months,6 months and 1 year was 72.5%,50.6% and 32.3%. Patients with paroxysmal AF,no heart failure and no stroke were associated with poor adherence of NOACs. Patient preference was the main reason for anticoagulant cessation.Conclusion Adherence of NOACs in patients with NVAF is poor with high rate of drug cessation. Multidisciplinary cooperation is needed for patients with paroxysmal AF,no heart failure and no stroke,to strengthen anticoagulation management and follow-up at the peak of drug discontinuation for the purpose of improving the quality of anticoagulation.

Key words: Atrial Fibrillation, Non-vitamin K Antagonist Oral Anticoagulants, Dabigatran, Rivaroxaban, Medication Adherence

摘要：

目的 调查非瓣膜病房颤患者服用新型口服抗凝药的依从性及其影响因素,并分析停药原因。方法 采用便利抽样法,对2016年3月—2018年3月某三级甲等医院服用新型口服抗凝药的133例非瓣膜病房颤患者进行调查,统计患者持续服药时间、停药原因和不良事件发生率。采用Kaplan-Meier法和Cox回归分析患者服用新型口服抗凝药的依从性及影响因素。结果 服用达比加群酯和利伐沙班的患者分别为101例(75.9%)和32例(24.1%)。患者持续服药中位时间为182 d,达比加群酯和利伐沙班的持续服药中位时间分别为182 d和305 d。生存分析显示,患者在3个月、6个月和1年时仍坚持服药的累积比例分别为72.5%,50.6%和32.3%。阵发性房颤、无心力衰竭和无脑卒中史是服药依从性差的主要因素,患者自行停药是抗凝终止的首要原因。结论 非瓣膜病房颤患者服用新型口服抗凝药的依从性差,服药3~6个月时需加强关注,提示应进行多学科合作,对阵发性房颤、无心力衰竭和无脑卒中史的患者加强抗凝管理,改善抗凝质量。

关键词: 心房颤动, 非维生素K拮抗剂口服抗凝药, 达比加群酯, 利伐沙班, 服药依从性