This study aimed to compare medication adherence and treatment persistence of patients on warfarin versus rivaroxaban in Singapore. A secondary objective was to identify signifi cant covariates infl uencing adherence. Materials and Methods: A retrospective cohort study was conducted where data from September 2009 to October 2014 was retrieved from the hospital electronic databases. Prescription records of rivaroxaban patients with 3 months or more of continuous prescription were extracted and compared against those of patients on warfarin. Primary outcome of adherence was determined based on the medication possession ratio (MPR), while treatment persistence was determined by outpatient clinic appointment gaps. Results: A total of 94 rivaroxaban and 137 warfarin users were analysed by complete case analysis. The MPR of warfarin patients was lower than rivaroxaban patients by 10% (95% CI, 6.4% to 13.6%; P <0.0001). Also, there were more warfarin patients who had gaps in treatment persistence compared to those prescribed rivaroxaban (8.0% vs 1.1%; P = 0.03). Signifi cant factors affecting medication adherence were age and duration of anticoagulant use. For every 10-year increase in age, MPR increased by 1.7% (95% CI, 0.7% to 2.8%). Similarly, for every year increase in duration of use, MPR increased by 1.8% (95% CI, 0.6% to 3.0%). Race, gender, concomitant medication and type of residence were not found to be signifi cant covariates in the multivariable analysis. Conclusion: Patients on rivaroxaban are likely to be more adherent to their prescribed oral anticoagulant with increasing age and duration of treatment infl uencing adherence.
Rivaroxaban is a non-vitamin K oral anticoagulant (NOAC) approved for use in Singapore since 2008 for the prevention of venous thromboembolism in patients undergoing total hip and knee replacement surgery. In March 2012, the registered indication was expanded to include prevention of stroke and systemic embolism in subjects with non-valvular atrial fi brillation, treatment of deep vein thrombosis (DVT), and the prevention of recurrent DVT and pulmonary embolism (PE).
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