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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

Patients’ self-reported adherence assessed with the MMAS-8.Notes: Only the patients who had returned the written questionnaire and had filled out the Morisky score at the end of the 1-year follow-up period (n=142) were included in the analysis, excluding patients or next-of-kin who provided their information via telephone interview.Abbreviations: MMAS-8, eight-point Morisky Medication Adherence Scale; VKA, vitamin K antagonists.
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f3-ppa-9-1695: Patients’ self-reported adherence assessed with the MMAS-8.Notes: Only the patients who had returned the written questionnaire and had filled out the Morisky score at the end of the 1-year follow-up period (n=142) were included in the analysis, excluding patients or next-of-kin who provided their information via telephone interview.Abbreviations: MMAS-8, eight-point Morisky Medication Adherence Scale; VKA, vitamin K antagonists.

Mentions: Of all three groups, the patients discharged on dabigatran showed the highest switching rate to other antithrombotic therapies (28.9%) as compared to patients receiving VKA (16.4%) and rivaroxaban (11.4%). Most patients who switched therapy were prescribed another OAT, and only 5%–10% of patients in each group discontinued OAT in general during the 1-year follow-up. Patients’ self-reported day-to-day medication adherence during the last 2 weeks as expressed on the MMAS-8 correlated well with the report to be on treatment with the specific OAT that had been prescribed at discharge. A total of 81.0% of patients taking VKA reported high adherence as compared to 84.8% of patients discharged on rivaroxaban and 70.3% of patients discharged on dabigatran (Figure 3, differences not significant). Comparing VKA with both NOAC grouped together, medication adherence did not differ significantly between both OAT strategies (VKA, 83.5%; NOAC, 75.8%; P=0.153).


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)

Patients’ self-reported adherence assessed with the MMAS-8.Notes: Only the patients who had returned the written questionnaire and had filled out the Morisky score at the end of the 1-year follow-up period (n=142) were included in the analysis, excluding patients or next-of-kin who provided their information via telephone interview.Abbreviations: MMAS-8, eight-point Morisky Medication Adherence Scale; VKA, vitamin K antagonists.
© Copyright Policy
Related In: Results  -  Collection

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

f3-ppa-9-1695: Patients’ self-reported adherence assessed with the MMAS-8.Notes: Only the patients who had returned the written questionnaire and had filled out the Morisky score at the end of the 1-year follow-up period (n=142) were included in the analysis, excluding patients or next-of-kin who provided their information via telephone interview.Abbreviations: MMAS-8, eight-point Morisky Medication Adherence Scale; VKA, vitamin K antagonists.
Mentions: Of all three groups, the patients discharged on dabigatran showed the highest switching rate to other antithrombotic therapies (28.9%) as compared to patients receiving VKA (16.4%) and rivaroxaban (11.4%). Most patients who switched therapy were prescribed another OAT, and only 5%–10% of patients in each group discontinued OAT in general during the 1-year follow-up. Patients’ self-reported day-to-day medication adherence during the last 2 weeks as expressed on the MMAS-8 correlated well with the report to be on treatment with the specific OAT that had been prescribed at discharge. A total of 81.0% of patients taking VKA reported high adherence as compared to 84.8% of patients discharged on rivaroxaban and 70.3% of patients discharged on dabigatran (Figure 3, differences not significant). Comparing VKA with both NOAC grouped together, medication adherence did not differ significantly between both OAT strategies (VKA, 83.5%; NOAC, 75.8%; P=0.153).

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