Persistence to direct oral anticoagulants for acute venous thromboembolism

Background: Currently, direct oral anticoagulants (DOACs) are the treatment of choice for venous thromboembolism (VTE) in the Netherlands. The main advantages of DOACs over vitamin K antagonists (VKAs) are that they are safer than VKA and that neither monitoring nor dose titrations are needed. A main drawback is a potential risk of lower drug persistence, as compared with VKA treatment, which is strictly controlled by anticoagulation clinics in the Netherlands. Objectives: The primary aim of this study was to audit the persistence to DOAC treatment for acute VTE during the first 2 months in daily clinical practice. Methods: Dispensing data from the Dutch Foundation of Pharmaceutical Statistics were used to monitor persistence to DOAC for treatment of VTE from 1 January 2012-1 April 2016. Non-persistence was defined as the cumulative incidence of patients who completely stopped DOAC or VKA treatment. In addition, we estimated the persistence to VKA treatment for VTE in data from the Anticoagulation Clinic Leiden. Results: 1834 patients were selected as DOAC users for the indication VTE. The 2-month cumulative incidence of completely stopping DOAC was 20% (95% confidence interval [CI] 18-24). In the population of 4910 VKA users, 9.1% (95% CI 8.3-9.9) stopped prematurely with VKA. Conclusion: The stopping rate of 20% we found is in line with other cardiovascular treatments. Further research into the reasons and consequences of prematurely stopping DOAC treatment for acute VTE is urgently needed.