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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

Multivariate analysis of factors influencing adherence to OAT in stroke patients.Notes: We analyzed all patients with available written or oral questionnaire (n=209) and adjusted for age, sex, mRS at discharge, and at 1-year follow-up and choice of OAT at discharge. *P<0.05.Abbreviations: CI, confidence interval; DOAC, direct oral anticoagulants; mRS, modified Ranking Scale score; OAT, oral anticoagulant therapy; OR, odds ratio; VKA, vitamin K antagonists.
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f4-ppa-9-1695: Multivariate analysis of factors influencing adherence to OAT in stroke patients.Notes: We analyzed all patients with available written or oral questionnaire (n=209) and adjusted for age, sex, mRS at discharge, and at 1-year follow-up and choice of OAT at discharge. *P<0.05.Abbreviations: CI, confidence interval; DOAC, direct oral anticoagulants; mRS, modified Ranking Scale score; OAT, oral anticoagulant therapy; OR, odds ratio; VKA, vitamin K antagonists.

Mentions: To identify factors that impede patients’ adherence to OAT after stroke, we compared the group of adherent patients (n=194) to the group of patients who reported to be non-adherent at follow-up (n=15). In a univariate analysis, the adherent group showed tendencies to be younger, with a lower disability score (mRS) and a higher degree of independence at 1-year follow-up (Table 3). The prescription frequencies of VKA and NOAC did not differ between the adherent and the non-adherent group. Multivariate analysis confirmed the degree of disability (mRS) at 1-year follow-up as an independent predictor of lower adherence (Figure 4).


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)

Multivariate analysis of factors influencing adherence to OAT in stroke patients.Notes: We analyzed all patients with available written or oral questionnaire (n=209) and adjusted for age, sex, mRS at discharge, and at 1-year follow-up and choice of OAT at discharge. *P<0.05.Abbreviations: CI, confidence interval; DOAC, direct oral anticoagulants; mRS, modified Ranking Scale score; OAT, oral anticoagulant therapy; OR, odds ratio; VKA, vitamin K antagonists.
© Copyright Policy
Related In: Results  -  Collection

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

f4-ppa-9-1695: Multivariate analysis of factors influencing adherence to OAT in stroke patients.Notes: We analyzed all patients with available written or oral questionnaire (n=209) and adjusted for age, sex, mRS at discharge, and at 1-year follow-up and choice of OAT at discharge. *P<0.05.Abbreviations: CI, confidence interval; DOAC, direct oral anticoagulants; mRS, modified Ranking Scale score; OAT, oral anticoagulant therapy; OR, odds ratio; VKA, vitamin K antagonists.
Mentions: To identify factors that impede patients’ adherence to OAT after stroke, we compared the group of adherent patients (n=194) to the group of patients who reported to be non-adherent at follow-up (n=15). In a univariate analysis, the adherent group showed tendencies to be younger, with a lower disability score (mRS) and a higher degree of independence at 1-year follow-up (Table 3). The prescription frequencies of VKA and NOAC did not differ between the adherent and the non-adherent group. Multivariate analysis confirmed the degree of disability (mRS) at 1-year follow-up as an independent predictor of lower adherence (Figure 4).

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