{"id":32460,"date":"2012-10-23T09:46:00","date_gmt":"2012-10-23T13:46:00","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=32460"},"modified":"2012-10-23T10:41:08","modified_gmt":"2012-10-23T14:41:08","slug":"high-rate-of-warfarin-discontinuation-observed-in-study","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/10\/23\/high-rate-of-warfarin-discontinuation-observed-in-study\/","title":{"rendered":"High Rate of Warfarin Discontinuation Observed in Study"},"content":{"rendered":"<p>One of the many potential problems with warfarin-based anticoagulant therapy is the poor rate of adherence and persistence among patients who are prescribed the drug. Now\u00a0<a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1384249\">an observational study published in the <em>Archives of Internal Medicine<\/em><\/a>\u00a0raises the possibility that the problem may be even worse than many have suspected, as discontinuation rates in clinical trials appear to be much lower than in the real world.<\/p>\n<p>Tara Gomes and colleagues analyzed data from more than 125,000 new users of warfarin in Ontario, Canada and found very high rates of discontinuation over time:<\/p>\n<ul>\n<li>8.9% never filled a second prescription.<\/li>\n<li>31.8% discontinued warfarin within 1 year.<\/li>\n<li>43.2% discontinued warfarin within 2 years.<\/li>\n<li>61.3% discontinued warfarin\u00a0within 5 years.<\/li>\n<\/ul>\n<p>People at higher risk for stroke, as assessed by the CHADS2 score, were more likely to continue taking warfarin over the course of the study.<\/p>\n<p>In<a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1384246\">\u00a0an invited commentary<\/a>, Whitney Maxwell and Charles Bennett write that the results are consistent with previous observational studies but that warfarin discontinuation can be appropriate and is often initiated by the physician. &#8220;Appropriateness of anticoagulation discontinuation is perhaps a more important outcome to evaluate rather than absolute discontinuation rates,&#8221; they write.\u00a0An additional plausible explanation for the finding is that few patients in Canada were treated at anticoagulation clinics.<\/p>\n<p>Maxwell and Bennett write that any potential problem with anticoagulation discontinuation is not limited to warfarin.\u00a0In the RE-LY trial, they note, more patients discontinued therapy in the dabigatran arm than in the warfarin arm, and a similar trend was observed with rivaroxaban in ROCKET AF.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>One of the many potential problems with warfarin-based anticoagulant therapy is the poor rate of adherence and persistence among patients who are prescribed the drug. Now\u00a0an observational study published in the Archives of Internal Medicine\u00a0raises the possibility that the problem may be even worse than many have suspected, as discontinuation rates in clinical trials appear [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[495,1],"tags":[365,341,339,366,368],"class_list":["post-32460","post","type-post","status-publish","format-standard","hentry","category-anticoagulation-2","category-general","tag-af","tag-atrial-fibrillation","tag-dabigatran","tag-rivaroxaban","tag-warfarin"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32460","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=32460"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32460\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=32460"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=32460"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=32460"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}