{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:31:11Z","timestamp":1790256671293,"version":"4.1.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"FI1","license":[{"start":{"date-parts":[[2020,4,23]],"date-time":"2020-04-23T00:00:00Z","timestamp":1587600000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Regional Ethical Review Board in Stockholm","award":["EPN 2015\/579-31\/2"],"award-info":[{"award-number":["EPN 2015\/579-31\/2"]}]},{"name":"Swedish Heart Lung Foundation"},{"DOI":"10.13039\/501100004348","name":"Stockholm County Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004348","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims\u2003<\/jats:title>\n                  <jats:p>Studies on adherence and persistence with non-vitamin K oral anticoagulant (NOAC) treatment have relied on data from the early years of NOAC availability. We aimed to study long-term adherence and persistence with NOACs and their association with stroke risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results\u2003<\/jats:title>\n                  <jats:p>From the Stockholm Healthcare database, we included 21\u2009028 atrial fibrillation patients claiming a first NOAC prescription from July 2011 until October 2018, with more than 1000 patients having more than 5\u2009years of follow-up (median: 2.0, interquartile range: 1.0\u20133.2). Persistence rates, defined as continuing to claim NOAC prescriptions within a 90-day gap, decreased to 70% at the end of follow-up. However, 85% of the patients were treated at the end of the study due to reinitiations. Adherence, calculated as medication possession rate (MPR) in 3 and 6-month intervals among persistent users, remained stable at 90%, with 75% of patients having an MPR &amp;gt;95% throughout the study period. Using a case\u2013control design, we calculated associations of persistence and adherence with stroke risk, adjusting for potential confounders. The outcome was a composite of ischaemic or unspecified stroke and transient ischaemic attack. Non-persistence and poor adherence were both associated with increased stroke risk [non-persistence adjusted odds ratio (aOR): 2.05; 95% confidence interval (CI): 1.49\u20132.82, 1% reduction MPR aOR: 1.03; CI: 1.01\u20131.05]. There was no association between non-persistence or poor adherence and the falsification endpoints; fractions and respiratory infections, indicating no \u2018healthy-adherer\u2019 effect.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion\u2003<\/jats:title>\n                  <jats:p>Persistence rates decreased slowly over time, but persistent patients had high adherence rates. Both non-persistence and poor adherence were associated with an increased stroke risk.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvaa017","type":"journal-article","created":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T11:09:41Z","timestamp":1587035381000},"page":"f72-f80","source":"Crossref","is-referenced-by-count":52,"title":["Long-term persistence and adherence with non-vitamin K oral anticoagulants in patients with atrial fibrillation and their associations with stroke risk"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5471-3132","authenticated-orcid":false,"given":"Joris J","family":"Komen","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands"},{"name":"Department of Healthcare Development, Stockholm County Council, Magnus Ladul\u00e5sgatan 63, 118 27 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5946-7209","authenticated-orcid":false,"given":"Eibert R","family":"Heerdink","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands"},{"name":"Research Group Innovations of Pharmaceutical Care, University of Applied Sciences Utrecht, Padualaan 101, 3584 CH Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5604-813X","authenticated-orcid":false,"given":"Olaf H","family":"Klungel","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aukje K","family":"Mantel-Teeuwisse","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2001-7710","authenticated-orcid":false,"given":"Tomas","family":"Forslund","sequence":"additional","affiliation":[{"name":"Department of Healthcare Development, Stockholm County Council, Magnus Ladul\u00e5sgatan 63, 118 27 Stockholm, Sweden"},{"name":"Department of Medicine Solna, Clinical Epidemiology Unit\/Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0531-2516","authenticated-orcid":false,"given":"Bj\u00f6rn","family":"Wettermark","sequence":"additional","affiliation":[{"name":"Department of Healthcare Development, Stockholm County Council, Magnus Ladul\u00e5sgatan 63, 118 27 Stockholm, Sweden"},{"name":"Department of Medicine Solna, Clinical Epidemiology Unit\/Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5346-275X","authenticated-orcid":false,"given":"Paul","family":"Hjemdahl","sequence":"additional","affiliation":[{"name":"Department of Medicine Solna, Clinical Epidemiology Unit\/Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Solna, SE-171 76 Stockholm, 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