Long-term adherence to direct acting oral anticoagulants and the influence of health beliefs after switching from vitamin-K antagonists: Findings from the Switching Study

Bartoli-Abdou, John K.; Patel, Jignesh P.; Vadher, Bipin; Brown, Alison; Roberts, Lara N.; Patel, Raj; Arya, Roopen; Auyeung, Vivian

doi:10.1016/j.thromres.2021.11.003

Cited by 9 publications

(8 citation statements)

References 56 publications

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“…Despite two-thirds of DOAC users in the aforementioned study by Capiau et al reported side effects (with easy bleeding (40.2%) being the most common for all DOACs), there was an overall positive attitude towards DOAC use [7]. Bartoli-Abdou et al found that believing that medications in general were overused in healthcare at baseline and that increasing concerns about anticoagulation over time while also having doubts concerning the necessity of the drug treatment were both associated with lower self-reported adherence [9].…”

Section: Introductionmentioning

confidence: 95%

“…Because adherence is of utmost importance in DOAC use and given the lack of monitoring and the poorer clinical outcomes associated with non-adherence a primary cut-off score of <24 to differentiate between non-adherent (score <24) and adherent (score [? ]24) patients is used in this study as non-adherence is easily underestimated with the MARS [9]. To evaluate sensitivity of the MARS-5 for assessing adherence to DOACs all analyses will be performed for the MARS-5 cut-off scores of <23 and <25 as well [19,20].…”

Section: Self-reported Adherencementioning

confidence: 99%

“…Ruff et al estimated long-term adherence for DOACs to be only in the 40-60% range [8]. One of the findings from the Switching Study conducted by Bartoli-Abdou et al was that after switching from VKA to DOAC 39% of patients had sub-optimal adherence measured by self-report [9].…”

Section: Introductionmentioning

confidence: 99%

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Medication adherence to direct oral anticoagulants: extent and impact of side effects

Steeg,

Esselink,

Wit

et al. 2024

Preprint

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Aim Recent studies have shown that good adherence cannot be taken for granted for patients on direct anticoagulants (DOACs). In this cross-sectional study, adherence among DOAC users was investigated and associations between beliefs about medication, perceived side effects and adherence were investigated. Methods We included 100 randomly selected adult DOAC users visiting one of the two participating Dutch community pharmacies in the summer of 2020. The self-reported adherence (primary outcome) was assessed with the Medication Adherence Rating Scale-5 (MARS-5). Beliefs about DOACs were assessed with the Beliefs about Medicine Questionnaire Specific (BMQ-S) while side effects were assessed with a self-developed questionnaire based on the Lareb Intensive Monitoring (LIM) system. Results Of the participants, 9% reported non-adherence on the MARS-5 (score <24). Associations were found between non-adherence and both reported side effects and side effect burden. Furthermore patients’ belief that DOACs have unpleasant side effects was associated with both non-adherence and more side-effects. No associations were found between adherence and either gender, indication, DOAC or dosage. Conclusion This study confirms that non-adherence in patients on DOACs is prevalent. We recommend that both physicians and pharmacists evaluate adherence and side effects with their DOAC patients on a regular base.

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Section: Introductionmentioning

confidence: 95%

Section: Self-reported Adherencementioning

confidence: 99%

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Medication adherence to direct oral anticoagulants: extent and impact of side effects

Steeg,

Esselink,

Wit

et al. 2024

Preprint

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“…However, they also carry a risk of bleeding which is inherent to their pharmacodynamic properties in preventing blood from clotting 16 . According to literature, there is still room for improvement concerning the adherence with DOACs 17–19 …”

Section: Introductionmentioning

confidence: 99%

“…16 According to literature, there is still room for improvement concerning the adherence with DOACs. [17][18][19] To fill major gaps on this topic, robust evidence from real-world data is warranted to better evaluate the magnitude of the potential harm for the NVAF population if DOAC discontinuation occurs. Using the BIFAP database we performed a nested case-control analysis to first estimate the frequency of IS on a cohort of new users of DOACs and second to estimate the association between DOAC discontinuation and risk of IS among patients with NVAF.…”

Section: Introductionmentioning

confidence: 99%

Risk of ischemic stroke associated with direct oral anticoagulants discontinuation on patients with non‐valvular atrial fibrillation

Álvaro Thomsen,

Mesa Guadalupe,

Huerta

et al. 2023

Pharmacoepidemiology and Drug

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IntroductionAlthough direct oral anticoagulants' (DOACs) prescriptions have experienced immense growth in the last decade, the proportion of discontinuers is still common yielding an increased risk of ischemic stroke (IS) onset.AimsWe aimed to estimate the association between DOACs discontinuation and risk of IS among patients with non‐valvular atrial fibrillation (NVAF).MethodsWe used data from a cohort of new DOACs users, followed patients from the first DOAC prescription date up to IS (index date) and conducted a nested case–control analysis using conditional logistic regression. Adjusted odds ratios, 95% confidence intervals were calculated for discontinuation of DOACs (current use compared with past use). The latter, subdivided among those stopping treatment 3 to 2 months and 6 and 3 months prior to index date. The effect of naïve current users against IS onset compared with non‐naïve current users was also evaluated.ResultsDOACs discontinuation showed an OR of IS of 1.47 (95% CI: 1.02–2.12); estimates were 2.51 (95% CI: 1.84–3.42) for whom discontinued treatment within months 3 and 2 and 1.43 (95% CI: 0.96–2.13) for those between months 6 and 3 prior to index date. Analyzing DOACs individually, risk of IS associated with past users compared with current users: 1.98 (95% CI: 1.25–3.12) for apixaban, 1.38 (95% CI: 0.40–4.72) for edoxaban, 1.98 (95% CI: 1.24–2.65) for dabigatran and 1.87 (95% CI: 1.26–2.76) for rivaroxaban. Similar results were found when stratified by naïve and non‐naïve users.ConclusionsDOACs' discontinuation is associated with higher risk of IS, especially in the second and third months following interruption.

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Measurement of adherence and health-related quality of life during anticoagulation therapy in cancer-associated venous thromboembolism (VTE): a multicenter quantitative study

Font,

Gomez-Mesa,

López-Núñez

et al. 2023

Support Care Cancer

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Therapy for cancer associated-venous thromboembolism (VTE) includes long term anticoagulation, which may have substantial impact on the health-related quality of life (HRQL) of patients. We assessed patient-reported outcomes to characterize the HRQL associated with VTE treatment and to begin to examine those HRQL elements impacting anticoagulation adherence (AA). MethodsParticipants were adult cancer patients with con rmed symptomatic acute lower extremity deep venous thrombosis. Patients were excluded if there was an indication for anticoagulation other than VTE, ECOG performance status > 3 or life expectancy < 3 months. Participants were assessed with a self-reported adherence tool. HRQL was measured with a 6-domain questionnaire using a seven-point Likert scale.Evaluations were performed at 30 days and 3 months after enrollment. For the primary objective, an overall adherence rate was calculated at each time point of evaluation. For the HRQL domains, nonparametric testing was used to compare results between subgroups. Results74 patients were enrolled. AA and HRQL at 30 days and 3 months were assessed in 50 and 36 participants, respectively. At 30 days the AA rate was 90% and at 3 months it was 83%. In regard to HRQL, patients suffered frequent and moderate-severe distress in the domains of emotional and physical symptoms, sleep disturbance and limitations to physical activity. An association between emotional or physical distress and AA was observed. ConclusionPatients with VTE suffer a substantial impairment of their HRQL. Increased distress correlated with better AA. These results can be used to inform additional research aimed at developing novel strategies to improve AA. BackgroundUp to 15% of all cancer patients develop venous thromboembolism (VTE) every year, and cancerassociated VTE causes signi cant morbidity and mortality [12,34]. The current standard of care for treatment of cancer associated-VTE is anticoagulation using low molecular weight heparin (LMWH) and/or direct oral anticoagulants (DOAC) for as long as cancer is active or the patient is receiving antineoplastic therapy [6,15,17, 18]. There are accumulating data, using both general and VTE-speci c

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Long-term adherence to direct acting oral anticoagulants and the influence of health beliefs after switching from vitamin-K antagonists: Findings from the Switching Study

Cited by 9 publications

References 56 publications

Medication adherence to direct oral anticoagulants: extent and impact of side effects

Medication adherence to direct oral anticoagulants: extent and impact of side effects

Risk of ischemic stroke associated with direct oral anticoagulants discontinuation on patients with non‐valvular atrial fibrillation

Measurement of adherence and health-related quality of life during anticoagulation therapy in cancer-associated venous thromboembolism (VTE): a multicenter quantitative study

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