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Research Article
5 August 2025

Evaluation of the treatment patterns among commercially insured patients with nonvalvular atrial fibrillation prescribed an oral anticoagulant by race/ethnicity

Authors: Michelle Zhang https://orcid.org/0009-0004-0038-2421, Risho Singh, Samina Dhuliawala, Dana Stafkey, Elisabeth Vodicka [email protected], Dong Cheng, Anandkumar Dubey, and Melissa HaganAuthor Info & Affiliations
Volume 14, Number 9
https://doi.org/10.57264/cer-2025-0057
PDFFormats

Abstract

Aim: Despite evidence of racial/ethnicity health inequities in oral anticoagulant initiation and clinical outcomes for nonvalvular atrial fibrillation, little is known about disparities in treatment patterns, particularly discontinuation and switching. Materials & methods: This retrospective study utilized Komodo Healthcare Map data (1 July 2018 to 30 June 2023) to examine treatment patterns in patients with nonvalvular atrial fibrillation initiating direct oral anticoagulants (DOACs: apixaban, rivaroxaban, dabigatran) versus warfarin, stratified by self-reported race/ethnicity (White, Black and Hispanic) in the USA. Inverse probability of treatment weighting balanced baseline covariates and Cox model computed adjusted hazard ratio (aHR) and 95% confidence interval (CI) for apixaban-warfarin and DOAC-warfarin comparisons in the overall cohort and by race/ethnicity. Results: In the apixaban-warfarin cohort, apixaban patients were 24% less likely to discontinue treatment (aHR: 0.76, 95% CI: 0.75–0.77) and 79% less likely to switch to another oral anticoagulant (aHR: 0.21, 95% CI: 0.20–0.22) versus warfarin. By race/ethnicity, a higher proportion of Black patients discontinued than White and Hispanic (68, 60 and 63%, respectively). Almost 5% of apixaban patients switched to another oral anticoagulant versus 31% on warfarin. Among warfarin switchers, 77% initiated apixaban (80% in White; 76% Black; 76% in Hispanic patients). The DOAC-warfarin cohort followed similar trends. Conclusion: Overall, apixaban/DOACs were associated with more favorable treatment patterns than warfarin. However, racial/ethnicity differences were observed. Given the potential impact of oral anticoagulant discontinuation on clinical outcomes, further research is needed to better understand factors contributing to higher discontinuation and switch rates, particularly among Black and Hispanic patients.

Plain language summary

What is this article about?

This study looks at how people with a heart condition called nonvalvular atrial fibrillation take blood-thinning medicines. It compares a newer class of medications, direct oral anticoagulants that include apixaban, rivaroxaban and dabigatran, to an older medication called warfarin. The focus is on different racial and ethnic groups, including White, Black and Hispanic patients in the US, using data from July 2018 to June 2023.
Understanding how people take their medicines is important because stopping or switching medication can lead to worse health outcomes. To our knowledge, this is the first study to report on how often people stop or switch between these medicines, specifically comparing trends across different racial and ethnic groups.

What were the results?

The study found that people who took apixaban were 24% less likely to stop their anticoagulant medication and 79% less likely to switch to a different medicine compared with those taking warfarin. However, Black patients were more likely to stop their medication (68%) than White (60%) or Hispanic (63%) patients.

What do the results of the study mean?

This means that apixaban may help patients take their medication longer compared with warfarin. But it also shows that Black patients tend to stop taking their medications more often than other groups. These findings are important in highlighting racial and ethnic differences in medication treatment persistence, which could impact health outcomes. Addressing these disparities may improve the effectiveness of anticoagulant medication therapy, especially for Black and Hispanic patients. Further research is needed to understand the reasons for these differences and to improve treatment continuity across all groups.

Shareable abstract

This study examines treatment patterns in nonvalvular atrial fibrillation patients using direct oral anticoagulants versus warfarin, focusing on racial/ethnic differences. Apixaban showed lower discontinuation and switching rates, but Black patients had higher discontinuation, highlighting treatment disparities.

Supplementary Material

File (supplementary data.docx)

References

Papers of special note have been highlighted as: • of interest
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