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Atrial fibrillation (AF) is a significant burden for healthcare systems due to increased morbidity and mortality rates. It is a major cause of ischaemic stroke, which is considered one of the most serious and disabling complications of AF. Stroke prevention with oral anticoagulation (OAC) by vitamin K antagonists (VKA) or non-vitamin K antagonists (NOAC) is therefore a significant component of AF management. Both VKAs and NOACs are effective for the prevention of stroke in AF; however, stringent adherence to the recommended treatment regimen is crucial, both from a prescriber’s and a patient’s perspective. Worldwide, stroke prevention in AF is suboptimal, with poor adherence to international guideline recommendations.1 Poor adherence is a major barrier to effective stroke prevention, reflected in inadequate time in therapeutic range (TTR) with VKA treatment. A proposed advantage of NOAC therapy is the lack of requirement for routine blood monitoring for therapeutic levels. However, this fact, along with a short plasma half-life of approximately 12 hours, means that adherence to therapy becomes even more crucial, and indeed non-persistence or discontinuation of OAC treatment can have devastating consequences.2
In this issue of the Journal, Jackevicius et al 3 published their findings on early non-persistence (within 6 months after initiation) with dabigatran and rivaroxaban in patients with AF. A retrospective cohort study was performed using linked administrative data from hospital admissions in Ontario, Canada, over a time period of 16 years (1998–2014). This cohort comprised patients aged ≥65 years with a diagnosis of AF prior to NOAC prescription. Given that both dabigatran and rivaroxaban were available on formulary from 2012 in Canada, all patients were considered new users of …
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