Download PDF
Thromb Haemost 2020; 120(02): 306-313
DOI: 10.1055/s-0039-1697954
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

NOAC Adherence of Patients with Atrial Fibrillation in the Real World: Dosing Frequency Matters?

Jongmin Hwang 
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Seongwook Han 
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Han-Joon Bae
2   Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea
,
Seung-Woon Jun
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Sang-Woong Choi
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Cheol-Hyun Lee
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
In-Cheol Kim
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Yun-Kyeong Cho
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Hyoung-Seob Park
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Hyuck-Jun Yoon
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Hyungseop Kim
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Chang-Wook Nam
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Seung-Ho Hur
1   Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
,
Sang-Hoon Lee
3   Division of Cardiology, Department of Internal Medicine, SM Christianity Hospital, Pohang, South Korea
› Author Affiliations Funding This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI17C2594).
Further Information

Publication History

05 April 2019

16 August 2019

Publication Date:
28 October 2019 (online)

Also available at
    Permissions and Reprints

Abstract

Background and Objectives Nonvitamin K antagonist oral anticoagulants (NOACs) require stricter medication adherence. We investigated the NOACs adherence in real-world practice.

Methods We screened all patients in our cardiology department the day before their outpatient appointment, over a 5-month period. We enrolled 719 consecutive patients who were taking NOACs for atrial fibrillation. The patients were contacted by phone or text to bring the remnant pills with them without any information why. Adherence was measured by the percentage of prescribed doses taken (PDT) (number of doses taken/number of doses expected to be taken from the last prescription × 100 [%]) and the Morisky Medication Adherence Scale (MMAS)-8.

Results All 4 NOACs (apixaban 47.8%, dabigatran 21.2%, rivaroxaban 18.4%, and edoxaban 12.6%) were prescribed. The mean duration that the patients had been taking NOACs was 7.2 ± 5.7 months. The PDT was 95.4 ± 9.1% in the once-daily dosing group and 93.4 ± 12.7% in the twice-daily group, and the difference was statistically significant (p = 0.017). The mean MMAS was 2.6 ± 0.8. The proportion of patients with a PDT < 80% was 7.8%. They had a significantly higher MMAS than the PDT ≥ 80% group (3.4 vs. 2.5; p = 0.000).

Conclusion Most patients who were taking NOACs had excellent adherence regardless of the dosing frequency. An MMAS ≥ 3 could be used as a simple screening tool for a poor NOAC adherence.

Keywords

medication adherence - anticoagulant - atrial fibrillation

Supplementary Material

Letter to this article:

The Compelling Issue of Nonvitamin K Antagonist Oral Anticoagulant Adherence in Atrial Fibrillation Patients: A Systematic Need for New StrategiesThromb Haemost 2020; 120(03): 369-371
DOI: 10.1055/s-0040-1702231

 

  • References

  • 1 Björck S, Palaszewski B, Friberg L, Bergfeldt L. Atrial fibrillation, stroke risk, and warfarin therapy revisited: a population-based study. Stroke 2013; 44 (11) 3103-3108
    CrossrefPubMedSearch in Google Scholar
  • 2 Chugh SS, Havmoeller R, Narayanan K. , et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014; 129 (08) 837-847
    CrossrefPubMedSearch in Google Scholar
  • 3 Henriksson KM, Farahmand B, Åsberg S, Edvardsson N, Terént A. Comparison of cardiovascular risk factors and survival in patients with ischemic or hemorrhagic stroke. Int J Stroke 2012; 7 (04) 276-281
    CrossrefPubMedSearch in Google Scholar
  • 4 Kotecha D, Holmes J, Krum H. , et al; Beta-Blockers in Heart Failure Collaborative Group. Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 2014; 384 (9961): 2235-2243
    CrossrefPubMedSearch in Google Scholar
  • 5 Kirchhof P, Benussi S, Kotecha D. , et al; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37 (38) 2893-2962
    CrossrefPubMedSearch in Google Scholar
  • 6 Yao X, Abraham NS, Alexander GC. , et al. Effect of adherence to oral anticoagulants on risk of stroke and major bleeding among patients with atrial fibrillation. J Am Heart Assoc 2016; 5 (02) e003074
    PubMedSearch in Google Scholar
  • 7 Crivera C, Nelson WW, Bookhart B. , et al. Pharmacy quality alliance measure: adherence to non-warfarin oral anticoagulant medications. Curr Med Res Opin 2015; 31 (10) 1889-1895
    CrossrefPubMedSearch in Google Scholar
  • 8 Vrijens B, De Geest S, Hughes DA. , et al; ABC Project Team. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol 2012; 73 (05) 691-705
    CrossrefPubMedSearch in Google Scholar
  • 9 De Geest S, Zullig LL, Dunbar-Jacob J. , et al. ESPACOMP Medication Adherence Reporting Guideline (EMERGE). Ann Intern Med 2018; 169 (01) 30-35
    CrossrefPubMedSearch in Google Scholar
  • 10 Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008; 10 (05) 348-354
    CrossrefPubMedSearch in Google Scholar
  • 11 Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24 (01) 67-74
    CrossrefPubMedSearch in Google Scholar
  • 12 Rasmussen JN, Chong A, Alter DA. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA 2007; 297 (02) 177-186
    CrossrefPubMedSearch in Google Scholar
  • 13 Gorst-Rasmussen A, Skjøth F, Larsen TB, Rasmussen LH, Lip GY, Lane DA. Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study. J Thromb Haemost 2015; 13 (04) 495-504
    CrossrefPubMedSearch in Google Scholar
  • 14 Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353 (05) 487-497
    CrossrefPubMedSearch in Google Scholar
  • 15 Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation 2009; 119 (23) 3028-3035
    CrossrefPubMedSearch in Google Scholar
  • 16 Bansilal S, Castellano JM, Garrido E. , et al. Assessing the impact of medication adherence on long-term cardiovascular outcomes. J Am Coll Cardiol 2016; 68 (08) 789-801
    CrossrefPubMedSearch in Google Scholar
  • 17 Sabaté E. Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization; 2003
    Search in Google Scholar
  • 18 Vrijens B, Heidbuchel H. Non-vitamin K antagonist oral anticoagulants: considerations on once- vs. twice-daily regimens and their potential impact on medication adherence. Europace 2015; 17 (04) 514-523
    CrossrefPubMedSearch in Google Scholar
  • 19 Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001; 23 (08) 1296-1310
    CrossrefPubMedSearch in Google Scholar
  • 20 Blaschke TF. Variable adherence to prescribed dosing regimens for protease inhibitors: scope and outcomes. Curr Opin HIV AIDS 2008; 3 (06) 603-607
    CrossrefPubMedSearch in Google Scholar
  • 21 Wallentin L, Becker RC, Budaj A. , et al; PLATO Investigators. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361 (11) 1045-1057
    CrossrefPubMedSearch in Google Scholar
  • 22 Connolly SJ, Ezekowitz MD, Yusuf S. , et al; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361 (12) 1139-1151
    CrossrefPubMedSearch in Google Scholar
  • 23 Schulman S, Shortt B, Robinson M, Eikelboom JW. Adherence to anticoagulant treatment with dabigatran in a real-world setting. J Thromb Haemost 2013; 11 (07) 1295-1299
    CrossrefPubMedSearch in Google Scholar
  • 24 Ho MH, Ho CW, Cheung E. , et al. Continuation of dabigatran therapy in “real-world” practice in Hong Kong. PLoS One 2014; 9 (08) e101245
    CrossrefPubMedSearch in Google Scholar
  • 25 Chan PH, Hai JJ, Huang D. , et al. Burden of upper gastrointestinal symptoms in patients prescribed dabigatran for stroke prevention. SAGE Open Med 2016; 4: 2050312116662414
    PubMedSearch in Google Scholar
  • 26 Staerk L, Gislason GH, Lip GY. , et al. Risk of gastrointestinal adverse effects of dabigatran compared with warfarin among patients with atrial fibrillation: a nationwide cohort study. Europace 2015; 17 (08) 1215-1222
    CrossrefPubMedSearch in Google Scholar
  • 27 Raparelli V, Proietti M, Cangemi R, Lip GY, Lane DA, Basili S. Adherence to oral anticoagulant therapy in patients with atrial fibrillation. Focus on non-vitamin K antagonist oral anticoagulants. Thromb Haemost 2017; 117 (02) 209-218
    Thieme ConnectPubMedSearch in Google Scholar