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Adherence to oral anticoagulant therapy in secondary stroke prevention - impact of the novel oral anticoagulants.

Luger S, Hohmann C, Niemann D, Kraft P, Gunreben I, Neumann-Haefelin T, Kleinschnitz C, Steinmetz H, Foerch C, Pfeilschifter W - Patient Prefer Adherence (2015)

Bottom Line: A total of 92% of these patients received OAT at the 1-year follow-up.We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran.Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany.

ABSTRACT

Background: Oral anticoagulant therapy (OAT) potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA) have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC) have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention.

Methods: All patients treated from October 2011 to September 2012 for ischemic stroke or transient ischemic attack with a subsequent indication for OAT, at three academic hospitals were entered into a prospective registry, and baseline data and antithrombotic treatment at discharge were recorded. At the 1-year follow-up, we assessed the adherence to different OAT strategies and patients' adherence to their respective OAT. We noted OAT changes, reasons to change treatment, and factors that influence persistence to the prescribed OAT.

Results: In patients discharged on OAT, we achieved a fatality corrected response rate of 73.3% (n=209). A total of 92% of these patients received OAT at the 1-year follow-up. We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran. Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence.

Conclusion: One-year adherence to OAT after stroke is strong (>90%) and patients who switch therapy most commonly switch toward another OAT. The 1-year adherence rates to VKA and NOAC in secondary stroke prevention do not differ significantly between both therapeutic strategies.

No MeSH data available.


Related in: MedlinePlus

Global neurological function of the patients at 1-year follow-up.Note: Graded on the modified Rankin Scale score (mRS) according to the written or oral answers of patients and/or their next-of-kin. (A) All participating patients, (B) by mode of participation.
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f2-ppa-9-1695: Global neurological function of the patients at 1-year follow-up.Note: Graded on the modified Rankin Scale score (mRS) according to the written or oral answers of patients and/or their next-of-kin. (A) All participating patients, (B) by mode of participation.

Mentions: Of the 596 patients entered into the registry, 324 (54.4%) had an OAT installed at discharge from our stroke units. The median length of stay was 7 days, 25%–75% interquartile range 5–11 days. These patients were followed up as a secondary prevention cohort (Figure 1). At 1-year follow-up, 159 of these patients or their next-of-kin (49.1%) returned the questionnaire by mail. In 11 cases (3.4%), we received the written information from patients’ next-of-kin that the patient had died and in an additional 21 cases (6.5%), the letter was returned with the postal annotation “recipient reported deceased”. In all other cases, we attempted to contact the patient and/or next-of-kin for a telephone interview. We conducted telephone interviews with 61 patients or next-of-kin (18.8%) and were informed orally by the patients’ next-of-kin that the patient had died during the follow-up period in seven cases (2.2%), leading to a cumulative 1-year mortality rate of 12.0%. Seventy-six patients (23.5%) were lost to follow-up, which amounts to a fatality corrected response rate of 73.3% (absolute response rate 64.5%). The mRS score distribution at 1-year follow-up showed that although we received information from patients with varying degrees of disability, the majority of patients who participated in the survey were fairly independent with only 20.5% reporting an mRS ≥3 (Figure 2) and 32.7% reporting to receive nursing care of any kind at home or in an institution. There was a significant difference in the proportion of patients depending on help in the activities of daily living (mRS >2) between patients spontaneously returning the written questionnaire and patients/families participating in the telephone interview (15.8% vs 34.4%, P=0.01).


Adherence to oral anticoagulant therapy in secondary stroke prevention - impact of the novel oral anticoagulants.

Luger S, Hohmann C, Niemann D, Kraft P, Gunreben I, Neumann-Haefelin T, Kleinschnitz C, Steinmetz H, Foerch C, Pfeilschifter W - Patient Prefer Adherence (2015)

Global neurological function of the patients at 1-year follow-up.Note: Graded on the modified Rankin Scale score (mRS) according to the written or oral answers of patients and/or their next-of-kin. (A) All participating patients, (B) by mode of participation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664488&req=5

f2-ppa-9-1695: Global neurological function of the patients at 1-year follow-up.Note: Graded on the modified Rankin Scale score (mRS) according to the written or oral answers of patients and/or their next-of-kin. (A) All participating patients, (B) by mode of participation.
Mentions: Of the 596 patients entered into the registry, 324 (54.4%) had an OAT installed at discharge from our stroke units. The median length of stay was 7 days, 25%–75% interquartile range 5–11 days. These patients were followed up as a secondary prevention cohort (Figure 1). At 1-year follow-up, 159 of these patients or their next-of-kin (49.1%) returned the questionnaire by mail. In 11 cases (3.4%), we received the written information from patients’ next-of-kin that the patient had died and in an additional 21 cases (6.5%), the letter was returned with the postal annotation “recipient reported deceased”. In all other cases, we attempted to contact the patient and/or next-of-kin for a telephone interview. We conducted telephone interviews with 61 patients or next-of-kin (18.8%) and were informed orally by the patients’ next-of-kin that the patient had died during the follow-up period in seven cases (2.2%), leading to a cumulative 1-year mortality rate of 12.0%. Seventy-six patients (23.5%) were lost to follow-up, which amounts to a fatality corrected response rate of 73.3% (absolute response rate 64.5%). The mRS score distribution at 1-year follow-up showed that although we received information from patients with varying degrees of disability, the majority of patients who participated in the survey were fairly independent with only 20.5% reporting an mRS ≥3 (Figure 2) and 32.7% reporting to receive nursing care of any kind at home or in an institution. There was a significant difference in the proportion of patients depending on help in the activities of daily living (mRS >2) between patients spontaneously returning the written questionnaire and patients/families participating in the telephone interview (15.8% vs 34.4%, P=0.01).

Bottom Line: A total of 92% of these patients received OAT at the 1-year follow-up.We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran.Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany.

ABSTRACT

Background: Oral anticoagulant therapy (OAT) potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA) have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC) have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention.

Methods: All patients treated from October 2011 to September 2012 for ischemic stroke or transient ischemic attack with a subsequent indication for OAT, at three academic hospitals were entered into a prospective registry, and baseline data and antithrombotic treatment at discharge were recorded. At the 1-year follow-up, we assessed the adherence to different OAT strategies and patients' adherence to their respective OAT. We noted OAT changes, reasons to change treatment, and factors that influence persistence to the prescribed OAT.

Results: In patients discharged on OAT, we achieved a fatality corrected response rate of 73.3% (n=209). A total of 92% of these patients received OAT at the 1-year follow-up. We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran. Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence.

Conclusion: One-year adherence to OAT after stroke is strong (>90%) and patients who switch therapy most commonly switch toward another OAT. The 1-year adherence rates to VKA and NOAC in secondary stroke prevention do not differ significantly between both therapeutic strategies.

No MeSH data available.


Related in: MedlinePlus