Ischemic stroke in patients previously anticoagulated for non-valvular atrial fibrillation: Why does it happen?

Fernandes, L. M. P.; Sargento-Freitas, João; Milner, James; Silva, Alexandra; Novo, Ana; Gonçalves, Tatiana Siqueira; Marinho, André; Pego, Guilherme Mariano; Cunha, Luís Miguel; António, Natália

doi:10.1016/j.repce.2018.06.007

Cited by 7 publications

(23 citation statements)

References 18 publications

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“…A total of 1156 records were retrieved after running the initial search. Overall, 19 studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] met the inclusion criteria of this systematic review, being selected for qualitative synthesis. A manual search was performed, with no identification of any study meeting the eligibility criteria.…”

Section: Flow Of Included Studiesmentioning

confidence: 99%

“…Brazil was the most cited country for the conduction of studies [19,22,25], followed by Australia [21,23], Saudi Arabia [14,24], and China [26,31]. The language of publication was English for most articles, except for one article [17] published in Portuguese from Portugal and for tree articles [19,22,25], published in Brazilian Portuguese.…”

Section: General Characteristics Of Included Studiesmentioning

confidence: 99%

“…Overall, four scales of medication adherence to warfarin therapy were identified in the selected studies, encompassing MMAS, MMAS-8, and Measurement of Treatment Adherence (MTA), contained items with specific questions about patients' behavior on the use of the medication. At last, Brief Medication Questionnaire (BMQ) appearing in two studies [17,18], contained items that led to information about barriers and determinants of adherence, such as patients' difficulties in buying and unpacking the medication. One of the studies employed a combination of two instruments to assess adherence (BMQ and MTA) [17].…”

Section: Content Of Adherence Scalesmentioning

confidence: 99%

“…At last, Brief Medication Questionnaire (BMQ) appearing in two studies [17,18], contained items that led to information about barriers and determinants of adherence, such as patients' difficulties in buying and unpacking the medication. One of the studies employed a combination of two instruments to assess adherence (BMQ and MTA) [17]. All these adherence scales explored forgetfulness as a barrier to adherence and contain items that seek to identify if there was discontinuation of treatment.…”

Section: Content Of Adherence Scalesmentioning

confidence: 99%

“…The MMAS instrument was used in its original format in studies that used it [14,16,19,27,28,30], while MMAS-8 was used in the original format in only three studies [20,21,29]. The MTA scale was used in the Portuguese version developed in Portugal in two studies [17,22], while the BMQ scale was used in its original version in one of the studies [18] and in the Portuguese version developed in Brazil in another [17].…”

Section: Content Of Adherence Scalesmentioning

confidence: 99%

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Self-report instruments for assessing adherence to warfarin therapy: a systematic review

Praxedes

Araújo

Ferreira

et al. 2021

Eur J Clin Pharmacol

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Background The assessment of adherence to warfarin therapy is useful in clinical practice due to its wide variability in dose-response and risks of complications. The aim of this study was to investigate validated instruments used to assess adherence to warfarin therapy. Methods Information was collected from the MEDLINE (PubMed), LILACS, EMBASE, and Cochrane Library databases. Search strategies were applied for each database, with no time limit or language restriction. Inclusion criteria consisted of study participants of ≥ 18 years of age, from both sexes, on chronic anticoagulation with warfarin for any indication and the use of validated instruments to assess adherence to warfarin therapy. Exclusion criteria consisted of duplicate articles, narrative or systematic reviews, and meta-analyses, as well as case reports/series and experimental studies involving animals. Two independent reviewers performed the following steps: evaluation of titles/abstracts, selection of studies after full reading, data extraction, and evaluation of potential bias. Discrepancies were resolved by a third reviewer. Results Overall, 19 articles were selected for this systematic review, including 17 cross-sectional studies, one cohort study, and one quasi-experimental study, published from 2009 to 2019. The validated instruments identified in this review were Morisky Medication Adherence Scale (MMAS), the eight-item Morisky Medication Adherence Scale (MMAS-8), Measurement of Treatment Adherence (MTA), and Brief Medication Questionnaire (BMQ). Only MMAS-8 was tested for reliability, using the internal consistency assessment, with Cronbach's α range 0.56-0.71. Conclusions This review highlighted a gap in knowledge regarding the scarcity of validated instruments to assess adherence to warfarin therapy. Limitations were found in instruments that comprised the assessment of the isolated use of medication and the lack of analysis of other relevant therapeutic aspects. Future studies are needed to develop and validate more comprehensive instruments in an attempt to assess adherence to warfarin therapy. PROSPERO Registration number CRD42019128324 Keywords Anticoagulants • Medication Adherence • Validation studies • Warfarin Key points• Adherence to prescribed drugs is currently a major obstacle for outpatients to achieve success in drug therapy. The assessment of adherence behaviors is useful to substantiate intervention strategies that seek to bring about changes in health outcomes as a consequence of drug therapies. • No adapted and validated instruments addressing specificities of warfarin therapy were found in this review. Current instruments to assess adherence to warfarin therapy address the isolated use of the medication with no items covering other relevant aspects of therapy, such as diet and drug interactions. • Further studies are needed to investigate specific scales in order to evaluate adherence to warfarin therapy, employing the assessment of their psychometric properties and applicability in clinical practiceExtended author inf...

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Section: Flow Of Included Studiesmentioning

confidence: 99%

Section: General Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Content Of Adherence Scalesmentioning

confidence: 99%

Section: Content Of Adherence Scalesmentioning

confidence: 99%

Section: Content Of Adherence Scalesmentioning

confidence: 99%

See 3 more Smart Citations

Self-report instruments for assessing adherence to warfarin therapy: a systematic review

Praxedes

Araújo

Ferreira

et al. 2021

Eur J Clin Pharmacol

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Characteristics and Mechanism of Acute Ischemic Stroke in NAVF Patients With Prior Oral Anticoagulant Therapy

Xue

Dong

et al. 2023

The Neurologist

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Objectives: We aimed to analyze the characteristics and mechanisms of acute ischemic stroke (AIS) in patients with nonvalvular atrial fibrillation (NVAF) who received prior anticoagulant therapy. Methods: We retrospectively analyzed the data of patients with NVAF and AIS between January 2016 and December 2021. Patients were divided into non-anticoagulant, adequate anticoagulant, and insufficient anticoagulant groups according to their prior anticoagulant status. Patients with prior anticoagulant therapy were further divided into warfarin and direct oral anticoagulant groups. Results: A total of 749 patients (661 without anticoagulants, 33 with adequate anticoagulants, and 55 with insufficient anticoagulants) were included. Patients with adequate anticoagulant had a milder National Institute of Health Stroke Scale at presentation (P=0.001) and discharge (P=0.003), a higher proportion of Modified Rankin Scale (mRS) ≤2 at discharge (P=0.011), and lower rates of massive infarction (P=0.008) than patients without anticoagulant. Compared with the non-anticoagulant group, the proportion of intravenous thrombolysis was significantly lower in the adequate anticoagulant (P<0.001) and insufficient anticoagulant (P=0.009) groups. Patients in the adequate anticoagulant group had higher rates of responsible cerebral atherosclerotic stenosis (P=0.001 and 0.006, respectively) and competing large artery atherosclerotic mechanisms (P=0.006 and 0.009, respectively) than those in the other 2 groups. Compared with warfarin, direct oral anticoagulant was associated with higher rates of Modified Rankin Scale ≤2 at discharge (P=0.003). Conclusions: Adequate anticoagulant therapy may be associated with milder stroke severity and better outcomes at discharge in patients with NVAF. Competing large artery atherosclerotic mechanisms may be associated with anticoagulant failure in patients with NAVF with prior adequate anticoagulant therapy.

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Estarão os Doentes com Fibrilhação Auricular Correctamente Anticoagulados? Um Retrato de um Hospital Português do Interior

Lima¹,

Aguiar

Paixão-Ferreira³

et al. 2021

RPMI

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Introdução: Os anticoagulantes orais (ACOs) demonstraram reduzir o risco de acidente vascular cerebral isquémico em doentes com fibrilhação auricular (FA). Contudo, a proporção de doentes que não está anticoagulada e tem indicação para estar é ainda elevada. O nosso objectivo é avaliar a proporção de doentes com FA que estão sob anticoagulação e avaliar a qualidade da prescrição de ACOs. Material e Métodos: Foi realizado um estudo observacional retrospectivo no Serviço de Medicina de um hospital do Alentejo (01-04/2019). Foram incluídos doentes com ≥18 anos, com história prévia de FA não-valvular e com CHA₂DS₂-VASc ≥ 2 (homens) ou ≥ 3 (mulheres). Extraiu-se o número de doentes que estava sob ACO e o número de doentes correctamente anticoagulado. Realizou-se análise estatística uni e bi-variada (IBM SPSS v.27.0). Resultados: Foram incluídos 203 doentes: 51,7% (n = 105) eram mulheres e a idade média foi 80,2 ± 9,4 anos. Cerca de 40% (n = 82) dos doentes não estavam sob ACO. Cinquenta e sete porcento (n = 20) dos doentes que tinham história prévia de eventos cerebrovasculares não estavam sob ACOs. Um quarto da amostra (n = 31) estava incorrectamente anticoagulada. Os doentes sob ACOs tendiam a ser mais novos e estar medicados um maior número de fármacos (p = 0,001 e p = 0,027, respectivamente). Conclusão: Os resultados sugerem que uma elevada proporção de doentes elegíveis para ACOs não estava medicada. Dos doentes medicados, um quarto estava incorrectamente anticoagulado. De forma a melhorar o padrão de prescrição, poder-se-ia considerar a optimização da formação contínua aos profissionais de saúde e o desenvolvimento de novos indicadores relativos à performance do sistema de saúde.

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Ischemic stroke in patients previously anticoagulated for non-valvular atrial fibrillation: Why does it happen?

Cited by 7 publications

References 18 publications

Self-report instruments for assessing adherence to warfarin therapy: a systematic review

Self-report instruments for assessing adherence to warfarin therapy: a systematic review

Characteristics and Mechanism of Acute Ischemic Stroke in NAVF Patients With Prior Oral Anticoagulant Therapy

Estarão os Doentes com Fibrilhação Auricular Correctamente Anticoagulados? Um Retrato de um Hospital Português do Interior

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