Non‐adherence to new oral anticoagulants: a reason for concern during long‐term anticoagulation?

Abstract

Laboratory test results were similar between the two groups. However, D-dimer (15.7 AE 79.7 mg L À1 vs. 2.3 AE 2.9 mg L À1 ; P = 0.439) and platelet count ([291.4 AE 120.5] 9 10 6 mL À1 vs. [323.5 AE 149.8] 9 10 6 mL À1 , P = 0.065) tended to be higher in PE patients. In the study group, D-dimer levels were significantly higher than normal ranges, probably because they can be non-specifically elevated in the setting of other acute disorders. However, D-dimer levels were not statistically different between suspected and diagnosed PE patients. Together, our results are very promising. Indeed, we did not compare PE patients with a group of healthy subjects, but with suspected cases of PE that were refuted after more thorough investigation. Thus, considering that all patients in our study were referred to the Radiology Department for suspected PE, we expected to find similar results in terms of clinical features and risk factors between the two groups, which was not the case. Therefore, our data indicate that the identified variables could be good indicators with which to differentiate a suspected from a confirmed PE in clinical practice. The assessment of a pretest clinical probability in clinical management is feasible in these patients, and could help to avoid unnecessary exposure of patients to radiation. In fact, many studies have focused on developing scoring systems to improve the predictive value for suspected PE as compared with variables measured individually [7]. In conclusion, although the clinical manifestations of PE are non-specific, this study indicates that preclinical probability testing could be very useful in identifying those patients with increased probability of having a PE, who could then benefit from early diagnosis and treatment. A limitation of this study was that it involved the retrospective assessment of a limited sample of patients recruited in a single center. Therefore, larger, prospective and multicenter studies are warranted to confirm these results and better determine the clinical characteristics and risk factors of PE in Saudi Arabian patients. AcknowledgementThe authors would like to thank the College of Medicine and Research Center, deanship of scientific research, King Saud University for supporting the study. Disclosure of Conflict of InterestsThe authors state that they have no conflict of interest. Non-adherence to new oral anticoagulants: a reason for concern during long-term anticoagulation? [4,[8][9][10][11][12][13][14]. This rate is significant if we consider that between 34% and 43% of patients receiving warfarin remain outside of their therapeutic range [15]. Poor adherence is an important factor to consider when explaining instability of anticoagulation control and the impact of under-dosing on the outcomes of patients receiving anticoagulants [8,12,13]. A study in 136 anticoagulated patients found that there was a significant association between under-adherence to warfarin and under-anticoagulation [8]. For each 10% increase in missed electronic 'pill bottle ope...

Pros and cons of new oral anticoagulants

“…coagulation monitoring. 21 This is especially critical in atrial fibrillation patients, most of whom have not experienced a thrombotic event. Warfarin's requirement for INR monitoring effectively allows adherence to be monitored.…”

Self-reported adherence to anticoagulation and its determinants using the Morisky medication adherence scale

“…(12)(13)(14) Despite addressing a number of the shortcomings regarding warfarin use, many concerns persist around the use of DOACs including medication adherence and lack of therapeutic monitoring as an indication of adherence. (15)(16)(17)(18)(19) Monitoring time in therapeutic range is a marker of quality of warfarin anticoagulation and can be used as sparsely reported in the literature. We performed a cross-sectional cohort study assessing the self-reported adherence of patients receiving anticoagulation therapy in a tertiary care hospital practice.…”

Pharmacy quality alliance measure: adherence to non-warfarin oral anticoagulant medications

“…6,7 The non-adherence rate of vitamin K antagonist (VKA) agents has been estimated between 22% to 58%. 8 The new non-vitamin K antagonist oral anticoagulants (NOACs) rivaroxaban, dabigatran, and apixaban have predictable pharmacokinetics, minimal fooddrug interactions, and do not require coagulation laboratory monitoring. [9][10][11] Despite these advantages as compared to warfarin, a recent meta-analysis of clinical trials reported that the rate of adherence and discontinuation of patients assigned to NOAC agents was similar to those assigned to warfarin.…”