{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:33:41Z","timestamp":1790883221034,"version":"4.1.0"},"reference-count":53,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,2,23]]},"abstract":"\n Background<\/jats:title>\n \n In comparison to warfarin, non\u2013vitamin K antagonist oral anticoagulants (\n NOAC<\/jats:styled-content>\n s) have the advantages of ease of dosing, fewer drug interactions, and lack of need for ongoing monitoring. We sought to evaluate whether these advantages translate to improved adherence and whether adherence is associated with improved outcomes in patients with atrial fibrillation.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We performed a retrospective cohort analysis by using a large\n US<\/jats:styled-content>\n commercial insurance database to identify 64\u00a0661 patients with atrial fibrillation who initiated warfarin, dabigatran, rivaroxaban, or apixaban treatment between November 1, 2010, and December 31, 2014. During a median of 1.1\u00a0y of follow\u2010up, 47.5% of\n NOAC<\/jats:styled-content>\n patients had a proportion of days covered of \u226580%, compared with 40.2% in warfarin patients (\n P<\/jats:italic>\n <0.001). Patients with\n CHA<\/jats:styled-content>\n 2<\/jats:sub>\n DS<\/jats:styled-content>\n 2<\/jats:sub>\n \u2010\n VAS<\/jats:styled-content>\n c (risk based on the presence of congestive heart failure, hypertension age 65\u201374 y, age \u226575 y, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, sex category) score \u22654 were at increased risk of stroke when they were not taking anticoagulation \u22651\u00a0month versus <1\u00a0week (1\u20133\u00a0months: hazard ratio [\n HR<\/jats:styled-content>\n ] 1.96, 3\u20136\u00a0months:\n HR<\/jats:styled-content>\n 2.64, \u22656\u00a0months:\n HR<\/jats:styled-content>\n 3.66; all\n P<\/jats:italic>\n <0.001). Patients with\n CHA<\/jats:styled-content>\n 2<\/jats:sub>\n DS<\/jats:styled-content>\n 2<\/jats:sub>\n \u2010\n VAS<\/jats:styled-content>\n c score 2 or 3 were at increased risk of stroke when they were not taking anticoagulation \u22656\u00a0months (\n HR<\/jats:styled-content>\n 2.73,\n P<\/jats:italic>\n <0.001). In these patients with\n CHA<\/jats:styled-content>\n 2<\/jats:sub>\n DS<\/jats:styled-content>\n 2<\/jats:sub>\n \u2010\n VAS<\/jats:styled-content>\n c score \u22652, nonadherence was not associated with intracranial hemorrhage. Among patients with\n CHA<\/jats:styled-content>\n 2<\/jats:sub>\n DS<\/jats:styled-content>\n 2<\/jats:sub>\n \u2010\n VAS<\/jats:styled-content>\n c score 0 or 1, time not taking anticoagulation was not associated with stroke, but not taking anticoagulation \u22653\u00a0months was associated with a significant reduction of bleeding.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Adherence to anticoagulation is poor in practice and may be modestly improved with\n NOAC<\/jats:styled-content>\n s. Adherence to therapy appears to be most important in patients with\n CHA<\/jats:styled-content>\n 2<\/jats:sub>\n DS<\/jats:styled-content>\n 2<\/jats:sub>\n \u2010\n VAS<\/jats:styled-content>\n c score \u22652, whereas the benefits of anticoagulation may not outweigh the harms in patients with\n CHA<\/jats:styled-content>\n 2<\/jats:sub>\n DS<\/jats:styled-content>\n 2<\/jats:sub>\n \u2010\n VAS<\/jats:styled-content>\n c score 0 or 1.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.115.003074","type":"journal-article","created":{"date-parts":[[2016,2,24]],"date-time":"2016-02-24T04:38:50Z","timestamp":1456288730000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":358,"title":["Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation"],"prefix":"10.1161","volume":"5","author":[{"given":"Xiaoxi","family":"Yao","sequence":"first","affiliation":[{"name":"Robert D. and Patricia E. 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Caleb","family":"Alexander","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD"},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Crown","sequence":"additional","affiliation":[{"name":"Optum Labs, Cambridge, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor M.","family":"Montori","sequence":"additional","affiliation":[{"name":"Division of Health Care Policy and Research, Department of Health Services Research, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey R.","family":"Sangaralingham","sequence":"additional","affiliation":[{"name":"Robert D. and Patricia E. 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