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Tan A, Kattinakere Sreedhara S, Russo M, Singer DE, Lauffenburger JC, DiCesare E, Lin KJ. Assessing methods to ascertain persistence and adherence of oral anticoagulants in patients with atrial fibrillation. Am Heart J 2024; 278:161-169. [PMID: 39303835 DOI: 10.1016/j.ahj.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 09/13/2024] [Accepted: 09/13/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Persistence and adherence to oral anticoagulants (OACs) is crucial for its effectiveness in stroke prevention in atrial fibrillation (AF). We aimed to assess the impact of different ascertainment methods on estimated persistence rates. METHODS We conducted a retrospective cohort study based on the Medicare claims data (01/01/2013-12/31/2019). We built an incident user cohort of OAC (apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin) prescription filling. We measured OAC medication persistence and adherence using the following approaches: (1) treatment-anniversary based persistence: if there is an active prescription overlapping the 180th and 365th day with vs. without a 15-day buffer period (i.e., overlapping with 165th-195th and 350th-380th day); (2) dispensing-gap-based persistence: if there is OAC discontinuation defined as having gap between prescriptions more than a threshold (e.g., 5-60 days) and secondarily, (3) proportion of days covered (PDC) adherence: proportion of days in which patient had filled medication available over the 365-day interval. RESULTS We identified 1,398,692 patients who initiated OACs during the study interval. With the treatment-anniversary based approach, only 51.2% to 65.4% of the patients persisted with the medication for either warfarin or DOACs at 180 days, and the number dropped to 43.4% to 60.7% at 1 year. Adding a 15-day buffer period increased the treatment-anniversary based persistence rates by 6.5% to 10.5%. When the allowable gap increased from 5 to 60 days, the persistence rates increased by 36.3% to 42.4% for all OACs. Apixaban users had the highest PDC (74%-75%) over the 365 days, compared to other OACs (60%-69%). CONCLUSIONS We found that the estimated persistence rates are sensitive to the choice of ascertainment methods. When reporting and comparing persistence findings using the claims database, definitions of OAC discontinuation must be clearly delineated.
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Affiliation(s)
- Anran Tan
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Sushama Kattinakere Sreedhara
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Massimiliano Russo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Daniel E Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Elyse DiCesare
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
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Al-Obaidi S, Hijazeen R, Arabyat RM, Alabbadi I. Adherence to oral anticoagulants in patients with non-valvular atrial fibrillation: the role of patients' characteristics and out-of-pocket payments. Expert Rev Pharmacoecon Outcomes Res 2024; 24:845-852. [PMID: 38967473 DOI: 10.1080/14737167.2024.2377663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Recent practice guidelines favor direct oral anticoagulants (DOACs) over warfarin for primary stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, challenges persist in Iraq's private pharmaceutical sector. DOACs have been sold at high and inconsistent retail prices and lack insurance coverage, leading to significant out-of-pocket (OOP) costs. The objective of this study is to investigate the impact of OOP costs on oral anticoagulants (OAC) adherence among NVAF patients. RESEARCH DESIGN AND METHODS This multicenter cross-sectional study interviewed 359 eligible patients attending three private cardiology clinics within Iraq's southern region from December 2022 to February 2023. The 8-item Morisky Adherence Scale evaluated patient adherence. Statistical analyses, including descriptive analysis, ANOVA, and chi-square. p < 0.05 was considered statistically significant. RESULTS The most frequently prescribed OAC were DOACs (62.8%). Patient adherence level to OAC was chiefly medium (54.6%) with no significant difference in adherence based on OAC type. Patient adherence was significantly associated with monthly income (p = 0.001), number of daily pills (p = 0.006), and OACs' average monthly cost (p = 0.011). CONCLUSION Addressing the issue of cost-related non-adherence to OACs requires multiple actions. These include ensuring comprehensive health insurance coverage for OACs, increasing the use of affordable generic alternatives, and establishing effective cost-related discussions between healthcare providers and patients.
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Affiliation(s)
- Siraj Al-Obaidi
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rima Hijazeen
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rasha M Arabyat
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Ibrahim Alabbadi
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
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Wang W, Chen LY, Walker RF, Alonso A, Norby FL, Lakshminarayan K, Lutsey PL. Percutaneous left atrial appendage occlusion and risk of stroke, hospitalized bleeding and death in Medicare beneficiaries. Pharmacoepidemiol Drug Saf 2024; 33:e5786. [PMID: 38565524 PMCID: PMC10996071 DOI: 10.1002/pds.5786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/12/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Among patients with atrial fibrillation (AF), a nonpharmacologic option (e.g., percutaneous left atrial appendage occlusion [LAAO]) is needed for patients with oral anticoagulant (OAC) contraindications. Among beneficiaries in the Medicare fee-for-service coverage 20% sample databases (2015-18) who had AF and an elevated CHA2DS2-VASc score, we assessed the association between percutaneous LAAO versus OAC use and risk of stroke, hospitalized bleeding, and death. METHODS Patients undergoing percutaneous LAAO were matched to up to five OAC users by sex, age, date of enrollment, index date, CHA2DS2-VASc score, and HAS-BLED score. Overall, 17 156 patients with AF (2905 with percutaneous LAAO) were matched (average ± SD 78 ± 6 years, 44% female). Cox proportional hazards model were used. RESULTS Median follow-up was 10.3 months. After multivariable adjustments, no significant difference for risk of stroke or death was noted when patients with percutaneous LAAO were compared with OAC users (HRs [95% CIs]: 1.14 [0.86-1.52], 0.98 [0.86-1.10]). There was a 2.94-fold (95% CI: 2.50-3.45) increased risk for hospitalized bleeding for percutaneous LAAO compared with OAC use. Among patients 65 to <78 years old, those undergoing percutaneous LAAO had higher risk of stroke compared with OAC users. No association was present in those ≥78 years. CONCLUSION In this analysis of real-world AF patients, percutaneous LAAO versus OAC use was associated with similar risk of death, nonsignificantly elevated risk of stroke, and an elevated risk of bleeding in the post-procedural period. Overall, these results support results of randomized trials that percutaneous LAAO may be an alternative to OAC use for patients with contraindications.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lin Yee Chen
- Lillehei Heart Institute and Department of Medicine (Cardiovascular Division), University of Minnesota Medical School, Minneapolis, Minnesota
| | - Rob F. Walker
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
- Department of Neurology, University of Minnesota, Minneapolis Minnesota
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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4
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Sawada M, Otsuka N, Nagashima K, Watanabe R, Wakamatsu Y, Hayashida S, Hirata S, Hirata M, Kurokawa S, Okumura Y. Clinical implication of the patient's disease awareness and adherence to medications in patients undergoing atrial fibrillation ablation. J Arrhythm 2024; 40:57-66. [PMID: 38333379 PMCID: PMC10848582 DOI: 10.1002/joa3.12965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 02/10/2024] Open
Abstract
Background The effects of the patient's disease awareness on the management of postablation of atrial fibrillation (AF) are unknown. Methods One hundred thirty-three AF patients undergoing an initial ablation were given a disease awareness questionnaire with a score of 16 points (8 points about AF in general and 8 points about oral anticoagulants) for the Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ) before and 1-year-after ablation. We divided them into the poor disease awareness group and good disease awareness group according to the median value (75%) of the total JAKQ score about AF in general, and compared the baseline patient characteristics and the 1-year changes in the JAKQ score, medication adherence, blood pressure, laboratory data, echocardiographic parameters, and AF/atrial tachycardia (AT) recurrence rate between the two groups. Results Forty-two (31.6%) patients were classified as having poor disease awareness (<75% of the total JAKQ score), which was closely associated with poor medication adherence, hypertension, diabetes, dyslipidemia, and greater left atrial volume (LAV). These trends in the poor disease awareness group remained unchanged 1 year after the ablation. During the 25.3-month follow-up, the AF/AT recurrence rate was significantly higher in the poor disease awareness than the good disease awareness group (23.8% vs. 7.7%; p = .003 by the log-rank test). Conclusions Poor disease awareness was linked to poor medication adherence, lifestyle-related diseases, and greater LAV before and even 1 year after the ablation, making it a potential surrogate marker for AF/AT recurrence. These findings highlight the clinical significance of disease awareness in AF management.
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Affiliation(s)
- Masanaru Sawada
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Naoto Otsuka
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Satoshi Hayashida
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Moyuru Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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Clerici B, Birocchi S, Podda GM. Non-adherence to chronic treatments: A commitment for Internal Medicine specialists. Eur J Intern Med 2024; 119:34-35. [PMID: 38123420 DOI: 10.1016/j.ejim.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Bianca Clerici
- Dipartimento di Scienza della Salute, S.C. Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Via di Rudinì, 8, Milano 20142, Italy
| | - Simone Birocchi
- Dipartimento di Scienza della Salute, S.C. Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Via di Rudinì, 8, Milano 20142, Italy
| | - Gian Marco Podda
- Dipartimento di Scienza della Salute, S.C. Medicina Generale II, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Via di Rudinì, 8, Milano 20142, Italy.
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Font C, Gomez-Mesa JE, López-Núñez JJ, Calderón C, Galindo-Coral S, Wu CC, Ma J, Kroll MH, Rojas-Hernandez CM. Measurement of adherence and health-related quality of life during anticoagulation therapy in cancer-associated venous thromboembolism (VTE): a multicenter quantitative study. Support Care Cancer 2023; 31:615. [PMID: 37801086 DOI: 10.1007/s00520-023-08073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE 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). METHODS Participants were adult cancer patients with confirmed 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, non-parametric testing was used to compare results between subgroups. RESULTS Seventy-four 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. CONCLUSION Patients with VTE suffer a substantial impairment of their HRQL. Increased emotional distress correlated with better long-term AA. These results can be used to inform additional research aimed at developing novel strategies to improve AA.
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Affiliation(s)
- Carme Font
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Juan Esteban Gomez-Mesa
- Departamento de Cardiología, Fundación Valle del Lili, Cali, Colombia
- Departamento de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Juan J López-Núñez
- Hospital Germans i Trias Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
| | - Caterina Calderón
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | | | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Junsheng Ma
- Biostatistics Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael H Kroll
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Dix C, Bortz H, da Gama M, Treloar M, Reynolds M, Ramanan R, Day T, Tran H. Adherence and persistence to direct factor Xa inhibitors in the community following newly diagnosed venous thromboembolism: a retrospective pharmacy-linkage study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:528-533. [PMID: 37494677 DOI: 10.1093/ijpp/riad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES To assess adherence and persistence to the direct factor Xa inhibitor oral anticoagulants in the community following newly diagnosed venous thromboembolism (VTE). METHODS We retrospectively reviewed community pharmacy dispensing data on all patients with newly diagnosed VTE who were prescribed direct factor Xa inhibitors, apixaban or rivaroxaban, between January 2018 and December 2019 at our institution. Proportion of days covered (PDC) was used to assess adherence at 90 days, and 6- and 12 months. Persistence was measured by participants having both dispensed supply of a factor Xa inhibitor at the end of the treatment period and no significant gaps (maximum of 60 days) in supply. KEY FINDINGS There were 225 patients identified. Overall PDC at 90 days, 6- and 12 months were 84.6%, 86.2% and 86.1%, respectively. Apixaban had a higher mean overall PDC than rivaroxaban (86.2% and 80.6%, respectively). Females demonstrated higher PDC compared with males (87.3% versus 81.2%). Overall, 133 patients (64%) were persistent with therapy. CONCLUSIONS In patients with newly diagnosed VTE treated with a factor Xa inhibitor, adherence rates are high at >80%, with females and those prescribed apixaban exhibiting higher adherence. These findings may assist clinicians in identifying those patients with VTE at risk of poor adherence.
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Affiliation(s)
- Caroline Dix
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Hadley Bortz
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | | | | | | | - Radha Ramanan
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Thomas Day
- Department of Haematology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Huyen Tran
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
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Ni YX, Liu LL, Feng H, Li Z, Qin CY, Chen M. Adherence, belief, and knowledge about oral anticoagulants in patients with bioprosthetic heart valve replacement: a cross-sectional study. Front Pharmacol 2023; 14:1191006. [PMID: 37502214 PMCID: PMC10369059 DOI: 10.3389/fphar.2023.1191006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Aims: To investigate adherence to oral anticoagulants among patients after mechanical heart valve (BHV) replacement and further examine the mediating role of medication belief in the relationship between knowledge and medication adherence. Background: The number of patients who undergo BHV replacement has increased in recent years. Short-term anticoagulant therapy is recommended for patients after BHV replacement. However, little is known about adherence to oral anticoagulant therapy and the underlying mechanisms among patients with BHV replacement. Methods: A cross-sectional study was conducted between September 2022 and November 2022. A convenience sample of 323 patients who underwent BHV replacement was recruited from a tertiary public hospital in Southwest China. Data were collected by using the 8-item Morisky Medication Adherence Scale, Beliefs about Medicines Questionnaire-specific, and the Knowledge of Anticoagulation Questionnaire. The mediation model was tested by Hayes's PROCESS macro. The STROBE checklist was used. Results: Approximately 17.3% of participants had low adherence, 47.1% had medium adherence, and only 35.6% reported high adherence to oral anticoagulants. Knowledge and necessity beliefs were positively related to medication adherence, while concern beliefs were negatively correlated with medication adherence. Medication belief mediated the relationship between knowledge and adherence to oral anticoagulants. Conclusion: Patients with BHV replacement demonstrated relatively low adherence to oral anticoagulant therapy. Efforts to enhance medication adherence should consider improving patients' knowledge and medication beliefs.
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Affiliation(s)
- Yun-Xia Ni
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lu-Lu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Huang Feng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Zhi Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Chao-Yi Qin
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Miao Chen
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Hayat A, Själander A, Wallvik J. Direct oral anticoagulants: patient reported adherence and minor bleedings. J Thromb Thrombolysis 2023:10.1007/s11239-023-02797-8. [PMID: 37119356 DOI: 10.1007/s11239-023-02797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/01/2023]
Abstract
Data regarding adherence and minor bleeding on direct oral anticoagulants in everyday life are still sparse. Inclusion criteria: treatment initiated with dabigatran, rivaroxaban or apixaban in non-valvular atrial fibrillation patients from a center in northern Sweden between 2011 and 2019 (n = 668). Exclusion criteria: cognitive impairment, dose dispensing, need of interpreter or hospital admission (n = 67). By a telephone interview adherence was measured in 569 patients (response rate 94.8%) using the 8-item Morisky medication adherence scale and minor bleeding was asked for. CHA2DS2-VASc and HAS-BLED scores were collected from medical records. The number (n), mean age, mean treatment duration, mean (points) CHA2DS2-VASc and HAS-BLED scores was with dabigatran (n = 175, 73.3 years, 17.8 months, 3.6 p and 2.2 p), rivaroxaban (n = 198, 73.7 years, 21months, 3.8 p and 2.1 p) and apixaban (n = 196, 72.7 years, 15.2 months, 3.4 p and 2.1 p). Adherence was high for dabigatran, rivaroxaban and apixaban in 54%, 76% and 53%; intermediate in 37%, 20% and 37% or low in 9%, 4% and 10% respectively. High adherence (Morisky score 8) distinguished rivaroxaban (p < 0.0001) and in patients with CHA2DS2-VASc ≥ 4 p, (p < 0.0001). Patients on rivaroxaban/apixaban reported more minor bleedings (37% / 28%) compared to dabigatran (13%), (p < 0.001). Only 61% of the patients followed prescription. Adherence to rivaroxaban was significantly better, maybe due to the once daily dosing regimen, and furthermore among patients with higher risk for stroke. Minor bleedings were less common in the dabigatran group. The impact of minor bleedings on adherence and a possible relationship to clinical outcomes need to be further studied.
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Affiliation(s)
- Amina Hayat
- Internal Medicine Clinic, Sundsvall hospital, 856 43, Sundsvall, Sweden.
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, 981 87, Sweden.
| | - Anders Själander
- Internal Medicine Clinic, Sundsvall hospital, 856 43, Sundsvall, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, 981 87, Sweden
| | - Jonas Wallvik
- Internal Medicine Clinic, Sundsvall hospital, 856 43, Sundsvall, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, 981 87, Sweden
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10
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Bonsu KO, Young SW, Lee T, Nguyen HV, Chitsike RS. Self-reported adherence to direct oral anticoagulants versus warfarin therapy in a specialized thrombosis service-a cross-sectional study of patients in a Canadian Health Region. Eur J Clin Pharmacol 2023; 79:117-125. [PMID: 36399203 DOI: 10.1007/s00228-022-03418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Direct oral anticoagulants (DOACs) have a better safety and efficacy profile than warfarin and are currently recommended for stroke prevention in non-valvular atrial fibrillation (AF) and treatment of venous thromboembolism (VTE). Given that DOACs do not require regular laboratory monitoring compared to warfarin, patients' interactions with the health care system is reduced. Adequate adherence to DOACs is important and reported adherence to anticoagulation is unclear in clinical practice. This study aims to assess self-reported adherence to oral anticoagulants in a specialized Adult Outpatient Thrombosis Service (TS). METHODS: This cross-sectional study included patients aged ≥ 18 years who were prescribed an oral anticoagulant and had attended at least one appointment with an Adult Outpatient Thrombosis Service (TS) between October 10, 2017, and May 31, 2019. Adherence to oral anticoagulant therapy was assessed using the 12-item validated Adherence to Refills and Medications Scale (ARMS) score. Logistic regression analyses were used to evaluate association between patient characteristics and medication adherence. Adherence rates in DOACs and warfarin were compared. RESULTS Three hundred and ninety-nine patients completed and returned the survey. Of the 399 who completed the survey, 74% were prescribed DOACs and 26% received warfarin. Most of the patients (89.3%) were ≥ 50 years of age and half (57.3%) were male. About two-thirds (67%) had at least post-secondary education. The duration of anticoagulation use differed between patients on DOAC and warfarin; a greater proportion of those who had used anticoagulants for less than 1 year was on DOACs compared to warfarin (20.9% vs 4.9%, p = 0.001). For patients who had been on anticoagulation for > 5 years, the proportion of warfarin patients was greater than DOAC (57.8% vs 20.5%, p = 0.001). Self-reported adherence to oral anticoagulant therapy using the 12-item ARMS scale for warfarin and DOACs were 87.3% and 90.9%, respectively. Among the warfarin users, patient satisfaction with TS was associated with medication adherence (OR = 0.22; 95% CI: 0.05-0.89). CONCLUSIONS Self-reported medication adherence was similar between warfarin and DOACs. Since suboptimal adherence is associated with poor clinical outcomes and increased costs, various stakeholders should emphasize the importance of medication adherence to oral anticoagulants at each patient encounter.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.
| | - Stephanie W Young
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.,Pharmacy Program, Eastern Region Health Authority, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
| | - Tiffany Lee
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.,Pharmacy Program, Eastern Region Health Authority, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
| | - Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
| | - Rufaro S Chitsike
- Division of Hematology, Eastern Region Health Authority, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.,Division of Medicine (Hematology), Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
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Malathi A, Jasim K. Validating the relationship between service quality, patient sensitivity and experience towards medical applications using SERVQUAL. Int J Med Inform 2022; 168:104883. [DOI: 10.1016/j.ijmedinf.2022.104883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
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Troshina DV, Andreev DA, Fomicheva AV, Volovchenko AN, Volel BA. Social and psychological risk factors for decreased adherence among patients with atrial fibrillation. TERAPEVT ARKH 2022; 94:1197-1203. [DOI: 10.26442/00403660.2022.10.201905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Indexed: 11/23/2022]
Abstract
Adherence has a direct impact on reducing the effectiveness of atrial fibrillation therapy and increasing the risk of thromboembolic events. Among the factors involved in the decrease of adherence, the social and psychological characteristics of patients remain insufficiently studied. At the same time, the available publications allow us to conclude that there are markers of the risk of reduced adherence in patients with atrial fibrillation, which include age, cognitive impairment, psychoemotional disorders (including depression and anxiety) and specific behavioral patterns.
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13
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Latif AA, Lee KW, Phang K, Rashid AA, Chan NN, Peh SC, Thilaganathan T, Ooi PB. Patient-related factors associated with medication adherence behavior in patients with end-stage renal disease: A systematic review. Tzu Chi Med J 2022; 34:473-484. [PMID: 36578649 PMCID: PMC9791854 DOI: 10.4103/tcmj.tcmj_212_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/02/2021] [Accepted: 03/11/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives This systematic review aims to identify influencing factors of medication adherence behavior in patients with end-stage renal disease (ESRD), with a special interest in patient-related factors based on the World Health Organization adherence model. Materials and Methods Primary electronic databases comprising PubMed, Scopus, Web of Science, Embase and Cochrane Library, as well as ProQuest (Health and Medical), ProQuest (Psychology), and EBSCOHost (APA PsychARTICLES) were used to search for literature on patient-related factors in medication adherence, from inception till August 31, 2021. Results 479 articles were identified and six articles meeting eligibility criteria were reviewed and remained in this systematic review. The present review found that despite different tools being used to measure ESRD's perception of medication's necessity and beliefs, there was a profound association between perception and beliefs with medication adherence behavior. There is a positive relationship between knowledge, belief, educational level, ethnicity, female, and medication adherence behavior. Mixed finding was reported between perception, age, and medication adherence behavior. However, there were no studies on patients' attitudes and medication adherence behavior as suggested in the WHO adherence model. Conclusion Only a limited number of patient-related factors were available for evaluation in the current systematic review. Additional research is needed to advance the understanding of medication adherence behavior affected by patient-related factors on the medication and illness. However, the findings must be taken with caution because of the limited studies included in this review.
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Affiliation(s)
- Anis A'lliya Latif
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Kai Wei Lee
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Kelly Phang
- Faculty of Psychology and Social Sciences, University of Cyberjaya, Selangor, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nee Nee Chan
- Department of Education, Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur, Malaysia
| | - Suat Cheng Peh
- Jeffrey Sachs Center, School of Interdisciplinary Studies, Sunway University, Selangor, Malaysia
| | | | - Pei Boon Ooi
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia,Department of General Studies, School of Interdisciplinary Studies, Sunway University, Selangor, Malaysia,Address for correspondence: Dr. Pei Boon Ooi, Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 5, Jalan Universiti, Bandar Sunway, 47500 Selangor, Malaysia. E-mail:
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Toma MM, Bungau SG, Tit DM, Moisi MI, Bustea C, Vesa CM, Behl T, Stoicescu M, Brisc CM, Purza LA, Gitea D, Diaconu CC. Use of anticoagulant drugs in patients with atrial fibrillation. Does adherence to therapy have a prognostic impact? Biomed Pharmacother 2022; 150:113002. [PMID: 35462339 DOI: 10.1016/j.biopha.2022.113002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/10/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022] Open
Abstract
Anticoagulant therapy represents a pivotal element that strongly influences the thromboembolic risk of non-valvular atrial fibrillation (NVAF) subjects. The main purpose of this review was to identify issues and suggest strategies to improve the oral anticoagulants (OACs) treatment adherence, which is the most important predictor of NVAF outcome. Advantages, efficacy, and impact of these drugs on patients' prognosis were revealed in important clinical trials on large cohorts of patients and are often prescribed nowadays. A real-life data registry, the Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) analyzed the profile and outcome of patients diagnosed with NVAF receiving oral antithrombotic treatment. The observations gathered in the registry were crucial for identifying relevant elements that clinicians must improve, such as adherence strategies and predisposing factors that correlated with stroke. Adherence to OACs in AF patients is essential from the viewpoint of clinical efficacy and safety. Major adverse events and negative outcome are correlated with a weak anticoagulation control caused by an ineffective treatment adherence strategy. Solving the issue of oral anticoagulation adherence is possible using new technologies, but future directions should be explored. Mobile phone applications centered on patients' needs, telemedicine programs that evaluate patients' evolution and detect adverse reactions or events, encouraging an adequate management of the event without interruption of OACs, represent perspectives with a major impact on treatment adherence.
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Affiliation(s)
- Mirela Marioara Toma
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410087, Romania.
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410087, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Delia Mirela Tit
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410087, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Madalina Ioana Moisi
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania.
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania.
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410073 Oradea, Romania.
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, 140401 Punjab, India.
| | - Manuela Stoicescu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
| | - Cristina Mihaela Brisc
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
| | - Lavinia Anamaria Purza
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Daniela Gitea
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania.
| | - Camelia Cristina Diaconu
- Department 5, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania; Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania.
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15
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Arkan G, Sarigol Ordin Y, Ozturk V, Ala RT. Investigation of Medication Adherence and Factors Affecting It in Patients With Stroke. J Neurosci Nurs 2022; 54:35-41. [PMID: 34775391 DOI: 10.1097/jnn.0000000000000621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: Medication adherence is important in reducing the rate of secondary stroke in patients previously given a diagnosis of stroke. Therefore, there is a need to examine medication adherence and the factors affecting it in these patients. This study aimed to examine medication adherence in patients with stroke and the factors affecting it. METHODS: This study adopted a descriptive and cross-sectional design carried carried out on 183 stroke patients. Data were obtained between January and December 2019 using a sociodemographic and clinical characteristics form, the Morisky's Questions - Self-Reported Measure of Medication Adherence, the Turkish translation of the Beliefs about Medicines Questionnaire, the Nottingham Extended Activities of Daily Living Scale, and the revised Turkish version of Mini-Mental State Examination. RESULTS: The proportion of patients with high medication adherence was 33.9%. The sociodemographic and clinical characteristics of patients with stroke were found as not effective factors in medication adherence. Specific concerns and general overuse in the Turkish translation of the Beliefs about Medicines Questionnaire were found as factors affecting medication adherence. The Nottingham Extended Activities of Daily Living Scale and its subscales were found to be not effective factors in medication adherence. CONCLUSION: According to the results, the proportion of patients with high medication adherence was low. Patients' concerns about the possible side effects of their prescribed medications and beliefs about the overuse of medications negatively affected their medication adherence. It is recommended that nurses evaluate patients' medication adherence and beliefs about medications during hospitalization, discharge, or home visits. Structured nurse-led intervention programs are needed to enhance patients' medication adherence and beliefs about their medications.
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Bonsu KO, Young S, Lee T, Nguyen H, Chitsike RS. Adherence to Antithrombotic Therapy for Patients Attending a Multidisciplinary Thrombosis Service in Canada - A Cross-Sectional Survey. Patient Prefer Adherence 2022; 16:1771-1780. [PMID: 35923661 PMCID: PMC9339664 DOI: 10.2147/ppa.s367105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Poor medication adherence puts patients who require antithrombotic therapy at greater risk of complications. We started a multidisciplinary Adult Outpatient Thrombosis Service in 2017 in a Canadian health authority and were interested in the level of medication adherence in the population attending. AIMS The aim of this study is to assess adherence to antithrombotic medications for patients attending a multidisciplinary Thrombosis Service. METHODS We conducted a cross-sectional survey of outpatients seen at the Thrombosis Service between 2017 and 2019 using the 12-item validated Adherence to Refills and Medications Scale (ARMS) to assess adherence to antithrombotic (anticoagulants and antiplatelet) therapy. Linear regression analysis examined the factors associated with adherence to antithrombotic therapy. RESULTS Of 1058 eligible patients, 53.2% responded to the survey. Seventeen were excluded from the analysis for missing more than 6 responses to the 12 items on the ARMS. About 55% (n = 297) were on direct oral anticoagulants (DOACs), 19% (n = 102) on warfarin, 5.0% (n = 27) on low molecular weight heparin, 3.3% (n = 18) on antiplatelet therapy and 18% (n = 96) were no longer on antithrombotic therapy. Nearly half (47%, n = 253) had taken antithrombotic therapy for 1-5 years while 28% (n = 150) and 25% (n = 137) had taken antithrombotic treatments for <1 and >5 years, respectively. Most patients (87%, n = 475) were ≥50 years and half (51%, n = 277) were male. The mean adherence score was 13.9 (SD±2.2) and 88% (n = 481) of participants were adherent to antithrombotic treatment (ARMS = 12-16). Multivariable linear regression showed that patients with post-graduate education had 0.4% lower adherence to antithrombotic therapy as compared with elementary education (β = 0.0039, p = 0.048). Patients with prior antithrombotic agent use >5 years had 0.5% lower adherence to antithrombotic treatment compared to patients with <1 year (β = 0.0047, p = 0.0244). CONCLUSION Self-reported adherence to antithrombotic therapy was high (88%) within a multidisciplinary Thrombosis Service. Patients with advanced education and prolong duration of antithrombotic therapy were more likely to have lower self-reported adherence to antithrombotic treatment.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Correspondence: Kwadwo Osei Bonsu, School of Pharmacy, Memorial University of Newfoundland and Labrador, 300 Prince Philip Drive, St John’s, NL, A1B 3V6, Canada, Email
| | - Stephanie Young
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Pharmacy Program, Eastern Region Health Authority, St John’s, NL, A1B 3V6, Canada
| | - Tiffany Lee
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Pharmacy Program, Eastern Region Health Authority, St John’s, NL, A1B 3V6, Canada
| | - Hai Nguyen
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
| | - Rufaro S Chitsike
- Division of Medicine (Hematology), Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Division of Hematology, Eastern Region Health Authority, St John’s, NL, A1B 3V6, Canada
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Speed V, Auyeung V, Patel JP, Cooper D, Miller S, Roberts LN, Patel RK, Arya R. Adherence to rivaroxaban for the treatment of venous thromboembolism-Results from the FIRST registry. Res Pract Thromb Haemost 2021; 5:e12614. [PMID: 34849447 PMCID: PMC8606029 DOI: 10.1002/rth2.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medication nonadherence can result in poor clinical outcomes and significant costs to health care providers. When treating venous thromboembolism (VTE), subtherapeutic anticoagulation may contribute to complications such as recurrent VTE or postthrombotic syndrome. OBJECTIVES To describe the extent, reasons for, and predictors of nonadherence to rivaroxaban for the treatment of VTE in clinical practice in the United Kingdom reported by participants of the FIRST registry. PATIENTS/METHODS The FIRST registry was an observational, multicenter registry reporting on the use of rivaroxaban in routine clinical practice. FIRST registry participants completed an adherence screening questionnaire during their treatment and follow-up. RESULTS In total, 1028 participants completed 1660 questionnaires over 2 years. One hundred thirteen of 1028 (11%) reported nonadherence at 28 days (interquartile range, 21-45). Reasons given for nonadherence at 1 month were forgetfulness (8.6% vs 74.7%; P < .001), carelessness (2.7% vs 27.3%; P < .001) or a change in routine (7.4% vs 25.5%; P < .001) reported by adherent and nonadherent participants, respectively. Older age (10-year increments) was the strongest predictor of good adherence (adjusted odds ratio, 1.21; 95% confidence interval, 1.06-1.39; 1 = adherent). CONCLUSIONS Overall adherence to rivaroxaban was high, and most nonadherence was unintentional. Identification of those at risk of nonadherence may reduce the risk of VTE recurrence and long-term complications.
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Affiliation(s)
- Victoria Speed
- King’s Thrombosis CentreDepartment of Haematological MedicineKing’s College Hospital NHS Foundation TrustLondonUK
- Institute of Pharmaceutical SciencesKing’s College LondonLondonUK
| | - Vivian Auyeung
- Institute of Pharmaceutical SciencesKing’s College LondonLondonUK
| | - Jignesh P. Patel
- King’s Thrombosis CentreDepartment of Haematological MedicineKing’s College Hospital NHS Foundation TrustLondonUK
- Institute of Pharmaceutical SciencesKing’s College LondonLondonUK
| | | | | | - Lara N. Roberts
- King’s Thrombosis CentreDepartment of Haematological MedicineKing’s College Hospital NHS Foundation TrustLondonUK
| | - Raj K. Patel
- King’s Thrombosis CentreDepartment of Haematological MedicineKing’s College Hospital NHS Foundation TrustLondonUK
| | - Roopen Arya
- King’s Thrombosis CentreDepartment of Haematological MedicineKing’s College Hospital NHS Foundation TrustLondonUK
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Bartoli-Abdou JK, Patel JP, Vadher B, Brown A, Roberts LN, Patel RK, Arya R, Auyeung V. 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. Thromb Res 2021; 208:162-169. [PMID: 34801919 DOI: 10.1016/j.thromres.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022]
Abstract
AIMS Switching non-adherent patients prescribed anticoagulant treatment to a regime with less monitoring could lead to significant non-adherence. Health beliefs are known to influence medication adherence; however, the extent of this influence is unknown in patients switched from vitamin-K antagonists (VKAs) to direct oral anticoagulants (DOACs). This study aimed to determine adherence to long-term therapy in patients switched from VKAs to DOAC due to low time in therapeutic range (TTR) and if adherence is associated with health beliefs. METHODS The Switching Study is a longitudinal observational cohort study following patients for at least 1-year. 254 patients anticoagulated with VKAs for stroke prevention in atrial fibrillation (AF) or secondary prevention of venous thromboembolism (VTE) and TTR < 50% were recruited from anticoagulation clinics at King's College Hospital, London, UK. All participants were switched to DOAC and had health beliefs measured at baseline with VKA, 1-month and 12-months after switching. RESULTS Of the 220 patients who completed 12-month follow-up 39% had sub-optimal adherence measured by self-report. 23% were non-adherent according to prescriptions issued. Increasing concerns about anticoagulation over time relative to beliefs about necessity was associated with lower self-reported adherence (OR = 0.902 95%C.I: 0.836, 0.974; p = 0.008). At baseline, believing that medications in general were overused in healthcare was negatively associated with adherence to DOAC (β = -1.5, 95%C.I: -2.7, -0.3; p = 0.013). CONCLUSIONS Although many patients who switched were adherent to therapy long-term, between 23 and 39% of patients exhibited sub-optimal adherence: these patients can be identified through their modifiable health beliefs at the time of switching.
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Affiliation(s)
- John K Bartoli-Abdou
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom; King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Jignesh P Patel
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom; King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Bipin Vadher
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Alison Brown
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lara N Roberts
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Raj K Patel
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Roopen Arya
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Vivian Auyeung
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
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Speed V, Patel JP, Cooper D, Miller S, Roberts LN, Patel RK, Arya R. Rivaroxaban in acute venous thromboembolism: UK prescribing experience. Res Pract Thromb Haemost 2021; 5:e12607. [PMID: 34723054 PMCID: PMC8531140 DOI: 10.1002/rth2.12607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/02/2021] [Accepted: 09/20/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Rivaroxaban was reported as effective as traditional therapies for the acute treatment of venous thromboembolism (VTE) with fewer major bleeding complications in the seminal Einstein program and is now a recommended option for the treatment of VTE around the world. OBJECTIVE To report the safety and efficacy of rivaroxaban in daily care for the management of acute VTE in the United Kingdom. PATIENTS/METHOD The FIRST registry is a UK-only, multicenter, noninterventional, observational VTE study (NCT02248610). Consecutive patients diagnosed with acute VTE, managed with rivaroxaban, were recruited and followed for up to 5 years. The primary outcomes were treatment-emergent symptomatic objectively diagnosed recurrent VTE, major and clinically relevant nonmajor bleeding (CRNMB), and all-cause mortality. RESULTS A total of 1262 participants were recruited between 2014 and 2018. Participants were heterogeneous, with age range 18 to 95 years, weight 35 to 234 kg, and maximum body mass index 64.4 kg/m2. The median duration of treatment exposure was 135 days (interquartile range [IQR], 84-307) and overall follow-up 497 days (IQR, 175-991). There were seven episodes of symptomatic VTE recurrence, 0.6%, (0.74/100 patient-years; 95% confidence interval [CI], 0.19-1.28). There were 79 of 1239 (6.4%), 8.66 of 100 patient-years (95% CI, 6.90-10.73) first episodes of major or CRNMB, which were most frequently reported by women aged <50 years as abnormal vaginal bleeding. CONCLUSIONS Rivaroxaban is an effective and safe single drug modality for the treatment of VTE in daily practice in the United Kingdom. Data to determine the optimal anticoagulation therapy for women of childbearing age are needed.
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Affiliation(s)
- Victoria Speed
- Department of Haematological MedicineKing's Thrombosis CentreKing's College Hospital NHS Foundation TrustLondonUK
- UK Institute of Pharmaceutical SciencesKing’s College LondonLondonUK
| | - Jignesh P. Patel
- Department of Haematological MedicineKing's Thrombosis CentreKing's College Hospital NHS Foundation TrustLondonUK
- UK Institute of Pharmaceutical SciencesKing’s College LondonLondonUK
| | | | | | - Lara N. Roberts
- Department of Haematological MedicineKing's Thrombosis CentreKing's College Hospital NHS Foundation TrustLondonUK
| | - Raj K. Patel
- Department of Haematological MedicineKing's Thrombosis CentreKing's College Hospital NHS Foundation TrustLondonUK
| | - Roopen Arya
- Department of Haematological MedicineKing's Thrombosis CentreKing's College Hospital NHS Foundation TrustLondonUK
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20
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Examining Adherence to Medication in Patients With Atrial Fibrillation: The Role of Medication Beliefs, Attitudes, and Depression. J Cardiovasc Nurs 2021; 35:337-346. [PMID: 32084080 DOI: 10.1097/jcn.0000000000000650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES This study examined whether beliefs about medicines, drug attitudes, and depression independently predicted anticoagulant and antiarrhythmic adherence (focusing on the implementation phase of nonadherence) in patients with atrial fibrillation (AF). METHODS This cross-sectional study was part of a larger longitudinal study. Patients with AF (N = 118) completed the Patient Health Questionnaire-8. The Beliefs about Medicines Questionnaire, Drug Attitude Inventory, and Morisky-Green-Levine Medication Adherence Scale (self-report adherence measure), related to anticoagulants and antiarrhythmics, were also completed. Correlation and multiple logistic regression analyses were conducted. RESULTS There were no significant differences in nonadherence to anticoagulants or antiarrhythmics. Greater concerns (r = 0.23, P = .01) were significantly, positively associated with anticoagulant nonadherence only. Depression and drug attitudes were not significantly associated with anticoagulant/antiarrhythmic adherence. Predictors reliably distinguished adherers and nonadherers to anticoagulant medication in the regression model, explaining 14% of the variance, but only concern beliefs (odds ratio, 1.20) made a significant independent contribution to prediction (χ = 11.40, P = .02, with df = 4). When entered independently into a regression model, concerns (odds ratio, 1.24) significantly explained 10.3% of the variance (χ = 7.97, P = .01, with df = 1). Regressions were not significant for antiarrhythmic medication (P = .30). CONCLUSIONS Specifying medication type is important when examining nonadherence in chronic conditions. Concerns about anticoagulants, rather than depression, were significantly associated with nonadherence to anticoagulants but not antiarrhythmics. Anticoagulant concerns should be targeted at AF clinics, with an aim to reduce nonadherence and potentially modifiable adverse outcomes such as stroke.
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21
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Vianna MS, da Silva Praxedes MF, de Araújo VE, Ferreira CB, de Sousa WJFN, Viana CC, Martins MAP. Self-report instruments for assessing adherence to warfarin therapy: a systematic review. Eur J Clin Pharmacol 2021; 77:1765-1781. [PMID: 34292359 DOI: 10.1007/s00228-021-03168-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/30/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Mayara Sousa Vianna
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Marcus Fernando da Silva Praxedes
- Centro de Ciências da Saúde, Universidade Federal Do Recôncavo da Bahia, Av. do Cajueiro, Cajueiro, Santo Antonio de Jesus, BA, Brazil
| | - Vânia Eloisa de Araújo
- Faculdade de Odontologia, Pontifícia Universidade Católica de Minas Gerais, Av: Dom José Gaspar, 500 Coração Eucarístico, Belo Horizonte, MG, 30535-901, Brazil
| | - Carolina Barbosa Ferreira
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Waleska Jaclyn Freitas Nunes de Sousa
- Faculdade de Medicina da, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | - Catiane Costa Viana
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil.
- Faculdade de Medicina da, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil.
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NAMLI Z, TAMAM L, DEMİRKOL ME, KARAYTUĞ MO, UĞUR K, ERİŞ Ö. Antidepresanların ilaç ilişkili hareket bozuklukları ve cinsel yan etkiler açısından karşılaştırılması. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.865933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kline JA, Adler DH, Alanis N, Bledsoe JR, Courtney DM, d'Etienne JP, Diercks DB, Garrett JS, Jones AE, Mackenzie DC, Madsen T, Matuskowitz AJ, Mumma BE, Nordenholz KE, Pagenhardt J, Runyon MS, Stubblefield WB, Willoughby CB. Monotherapy Anticoagulation to Expedite Home Treatment of Patients Diagnosed With Venous Thromboembolism in the Emergency Department: A Pragmatic Effectiveness Trial. Circ Cardiovasc Qual Outcomes 2021; 14:e007600. [PMID: 34148351 DOI: 10.1161/circoutcomes.120.007600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The objective was to test if low-risk emergency department patients with vitamin K antagonist (venous thromboembolism [VTE]; including venous thrombosis and pulmonary embolism [PE]) can be safely and effectively treated at home with direct acting oral (monotherapy) anticoagulation in a large-scale, real-world pragmatic effectiveness trial. METHODS This was a single-arm trial, conducted from 2016 to 2019 in accordance with the Standards for Reporting Implementation Studies guideline in 33 emergency departments in the United States. Participants had newly diagnosed VTE with low risk of death based upon either the modified Hestia criteria, or physician judgment plus the simplified PE severity index score of zero, together with nonhigh bleeding risk were eligible. Patients had to be discharged within 24 hours of triage and treated with either apixaban or rivaroxaban. Effectiveness was defined by the primary efficacy and safety outcomes, image-proven recurrent VTE and bleeding requiring hospitalization >24 hours, respectively, with an upper limit of the 95% CI for the 30-day frequency of VTE recurrence below 2.0% for both outcomes. RESULTS We enrolled 1421 patients with complete outcomes data, including 903 with venous thrombosis and 518 with PE. The recurrent VTE requiring hospitalization occurred in 14/1421 (1.0% [95% CI, 0.5%-1.7%]), and bleeding requiring hospitalization occurred in 12/1421 (0.8% [0.4%-1.5%). The rate of severe bleeding using International Society for Thrombosis and Haemostasis criteria was 2/1421 (0.1% [0%-0.5%]). No patient died, and serious adverse events occurred in 2.5% of venous thrombosis patients and 2.3% of patients with PE. Medication nonadherence was reported by patients in 8.0% (6.6%-9.5%) and was associated with a risk ratio of 6.0 (2.3-15.2) for VTE recurrence. Among all patients diagnosed with VTE in the emergency department during the period of study, 18% of venous thrombosis patients and 10% of patients with PE were enrolled. CONCLUSIONS Monotherapy treatment of low-risk patients with venous thrombosis or PE in the emergency department setting produced a low rate of bleeding and VTE recurrence, but may be underused. Patients with venous thrombosis and PE should undergo risk-stratification before home treatment. Improved patient adherence may reduce rate of recurrent VTE. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03404635.
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Affiliation(s)
- Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (J.A.K.)
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, NY (D.H.A.)
| | - Naomi Alanis
- Department of Emergency Medicine, University of North Texas, Denton (N.A.)
| | - Joseph R Bledsoe
- Department of Emergency Medicine, Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, UT (J.R.B.)
| | - Daniel M Courtney
- Department of Emergency Medicine, University of Texas Southwestern, Dallas (D.M.C., D.B.D.)
| | - James P d'Etienne
- Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, TX (J.P.d.)
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas Southwestern, Dallas (D.M.C., D.B.D.)
| | - John S Garrett
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX (J.S.G.)
| | - Alan E Jones
- Department of Emergency Medicine, University of Mississippi, Jackson (A.E.J.)
| | - David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland (D.C.M.)
| | - Troy Madsen
- Department of Emergency Medicine, University of Utah, Salt Lake City (T.M.)
| | - Andrew J Matuskowitz
- Department of Emergency Medicine, Medical University of South Carolina, Charleston (A.J.M.)
| | - Bryn E Mumma
- Department of Emergency Medicine, University of California, Davis (B.E.M.)
| | | | - Justine Pagenhardt
- Department of Emergency Medicine, West Virginia University, Morgantown (J.P.)
| | - Michael S Runyon
- Department of Emergency Medicine, Atrium Health, Charlotte, NC (M.S.R.)
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville TN (W.B.S.)
| | - Christopher B Willoughby
- Department of Internal Medicine, Division of Emergency Medicine, Louisiana State University, New Orleans (C.B.W.)
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Shiga T, Kimura T, Fukushima N, Yoshiyama Y, Iwade K, Mori F, Ajiro Y, Haruta S, Yamada Y, Sawada E, Hagiwara N. Electronic monitoring of adherence to once-daily and twice-daily direct oral anticoagulants in patients with atrial fibrillation: Baseline data from the SMAAP-AF trial. J Arrhythm 2021; 37:616-625. [PMID: 34141014 PMCID: PMC8207342 DOI: 10.1002/joa3.12532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nonadherence diminishes the efficacy of direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (NVAF). This report presents the baseline survey results regarding medication adherence among NVAF patients who were treated with once-daily edoxaban or twice-daily apixaban from a randomized control trial of the effect of an educational intervention on DOAC adherence. METHODS We prospectively studied 301 NVAF patients who were treated with edoxaban (n = 175) or apixaban (n = 126) during the 12-week observation period. Adherence was measured with an electronic monitoring system and is expressed as the percentage of days with the correct doses in the measurement period (days). Adherence to DOAC therapy was defined based on the standard threshold (≥80%) or a strict threshold (≥90%). RESULTS Of the 301 patients, 33 had incomplete data or protocol deviations, leaving 268 patients (edoxaban 158 and apixaban 110) for the per-protocol baseline analysis. There was no difference in adherence (threshold ≥80%) between the groups (edoxaban 95% vs apixaban 91%, P = .2), but there was a lower proportion of patients with strict adherence (threshold ≥90%) among apixaban users than among edoxaban users (edoxaban 87% vs apixaban 76%, P = .02). Multivariate analysis showed a negative relationship between apixaban use and an adherence rate ≥90% (odds ratio 0.49, 95% confidence interval [CI]: 0.25-0.94). CONCLUSIONS Our study showed that the proportion of DOAC users with adherence (≥80%) did not differ between the groups, but the proportion of patients with strict adherence (≥90%) was lower among those using apixaban than among those using edoxaban.
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Affiliation(s)
- Tsuyoshi Shiga
- Department of CardiologyTokyo Women’s Medical UniversityTokyoJapan
- Department of Clinical Pharmacology and TherapeuticsThe Jikei University School of MedicineTokyoJapan
| | - Toshimi Kimura
- Department of PharmacyTokyo Women’s Medical University HospitalTokyoJapan
| | - Noritoshi Fukushima
- Department of Preventive Medicine and Public HealthTokyo Medical UniversityTokyoJapan
| | | | - Kazunori Iwade
- Department of CardiologyNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Fumiaki Mori
- Department of CardiologyNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Yoichi Ajiro
- Department of CardiologyNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Shoji Haruta
- Department of CardiologyTokyo Women’s Medical University Yachiyo Medical CenterYachiyoJapan
| | - Yuichiro Yamada
- Department of CardiologyTokyo Women’s Medical University Yachiyo Medical CenterYachiyoJapan
| | - Emi Sawada
- Department of CardiologyTokyo Women’s Medical UniversityTokyoJapan
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Paquette M, Mbuagbaw L, Iorio A, Nieuwlaat R. Methodological considerations for investigating oral anticoagulation persistence in atrial fibrillation. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 7:251-260. [PMID: 32428195 PMCID: PMC8141301 DOI: 10.1093/ehjcvp/pvaa052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/20/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022]
Abstract
AIMS Reports of long-term oral anticoagulant (OAC) therapy for atrial fibrillation (AF) reveal highly variable, and generally suboptimal estimates of medication persistence. The objective of this review is to summarize current literature and highlight important methodological considerations for interpreting persistence research and designing studies of persistence on OAC treatment. METHODS AND RESULTS We summarize differences in study methodology, setting, timing, treatment, and other factors associated with reports of better or worse persistence. For example, prospective compared with retrospective study designs are associated with higher reported persistence. Similarly, patient factors such as permanent AF or high stroke risk, and treatment with non-vitamin K oral antagonists relative to vitamin K antagonists are associated with higher persistence. Persistence has also been reported to be higher in Europe compared with North America and higher when the treating physician is a general practitioner compared with a specialist. We propose a framework for assessing and designing persistence studies. This framework includes aspects of patient selection, reliability and validity of measures, persistence definitions, clinical utility of measurements, follow-up periods, and analytic approaches. CONCLUSIONS Differences in study design, patient selection, treatments, and factors such as the countries/regions where studies are conducted or the type of treating physician may help explain the variability in OAC persistence estimates. A framework is proposed to assess persistence studies. This may have utility to compare and interpret published studies as well as for planning of future studies.
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Affiliation(s)
- Miney Paquette
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
- Department of Medicine, Boehringer Ingelheim Ltd, Burlington, ON L7L 5H4, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- Centre for the Development of Best Practices in Health, Yaoundé, Cameroon
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
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Transition of care for pediatric and adult patients with venous thromboembolism: A National Quality Improvement Project from the American Thrombosis and Hemostasis Network (ATHN). Thromb Res 2021; 200:23-29. [PMID: 33517168 DOI: 10.1016/j.thromres.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transition of care (TOC) for management of anticoagulation from inpatient to outpatient setting for patients with acute venous thromboembolism (VTE) poses serious safety concerns. We implemented a national quality improvement educational initiative to address this issue. METHODS Pediatric and adult patients admitted for their first VTE were prospectively enrolled at 16 centers from January 2016 to December 2018. Patient demographics, VTE diagnosis, risk factors, and treatment characteristics were collected. There were two phases: pre-intervention (PI) and quality intervention (QI). The PI phase assessed the quality and patient understanding and satisfaction of anticoagulation instructions given at hospital discharge and adherence to these instructions via a patient and/or caregiver feedback questionnaire (PFQ) and a patient knowledge questionnaire (PKQ) at 30 days. The QI phase provided patient and/or caregiver enhanced education regarding anticoagulation therapy and VTE at hospital discharge using a comprehensive discharge instruction module and a phone call follow-up at one week. Patient and/or caregiver knowledge at 7 and 30 days was assessed with the same PFQ and PKQ and compared to the PI baseline measures. RESULTS Of the 409 study patients, 210 (51%) were adults, 218 (53%) females, and 316 (77%) White. Deep vein thrombosis (62.8%) and pulmonary embolism (47.9%) were the most common VTE in children and adults, respectively. Day 30 PFQ scores were significantly higher in the QI phase compared to the PI phase by 11% (p < 0.01). Day 30 PKQ demonstrated enhanced teaching (93.7% vs. 83.5%, p-value 0.004) and disease recognition (89.6% vs. 84.6% p = 0.03) in the QI phase than the PI phase. CONCLUSION Comprehensive VTE discharge instructions followed by a 1-week post-discharge phone call strengthen patient and caregiver knowledge, satisfaction of education given and care provided, and disease recognition.
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Henry M, Wosnitza M, Thate-Waschke IM, Bauersachs R, Ueng KC, Chang KC, Wilke T. Country-based Comparison of Atrial Fibrillation Patients' Preferences for Oral Anticoagulation: An Evaluation of Discrete Choice Experiments in Five Different Countries. J Cardiovasc Pharmacol 2021; 77:100-106. [PMID: 33165142 DOI: 10.1097/fjc.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/13/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT The aim of this study was to examine atrial fibrillation (AF) patients' preferences regarding oral anticoagulation (OAC) characteristics and to investigate differences across 5 different countries. A multicenter discrete choice experiment was conducted in Germany, Sweden, Switzerland, Spain, and Taiwan. Study sites enrolled patients with nonvalvular AF who received continuous OAC therapy. The discrete choice experiment design considered the following 4 attributes with 2 attribute levels each: need for bridging (yes/no), interactions with food/alcohol (yes/no), need for regular international normalized ratio (INR) assessments, and frequency of intake (once/twice daily). Generally, patients (n = 1391) preferred treatment alternatives that were characterized by "no need of bridging," "no need for regular INR controls," "no interactions with food/alcohol," and "once daily intake." For this desired treatment regimen, patients were willing to accept a substantially higher travel distance/time. German patients with AF were strongly impacted in their hypothetical treatment decision by the frequency of intake (37.5%). Swedish patients on the other hand gave little importance to intake frequency (12.6%). In Switzerland, patients were especially concerned with food/alcohol interactions of the medication (34.7%), whereas this was the least important attribute for Taiwanese patients (18.9%), who ascribed the most homogenous importance to the different treatment attributes overall. In Spain, the need for regular INR assessments especially impacted the patient's treatment decision (31.9%). Patients of all countries attributed a moderate importance to the need for bridging (25.9%-34.2%). These findings may facilitate country-specific consideration of patients' preferences regarding OAC therapy, potentially increasing treatment acceptance on the patient's side with the ultimate goal of improving treatment adherence and persistence.
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Moudallel S, van den Bemt BJF, Zwikker H, de Veer A, Rydant S, Dijk LV, Steurbaut S. Association of conflicting information from healthcare providers and poor shared decision making with suboptimal adherence in direct oral anticoagulant treatment: A cross-sectional study in patients with atrial fibrillation. PATIENT EDUCATION AND COUNSELING 2021; 104:155-162. [PMID: 32622691 DOI: 10.1016/j.pec.2020.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess direct oral anticoagulant (DOAC) adherence and to determine possible determinants for suboptimal adherence in Dutch patients with atrial fibrillation (AF). METHODS Cross-sectional study of DOAC users who completed a self-reported questionnaire. Adherence was measured with Morisky8-item Medication Adherence Scale (MMAS-8). Logistic regression analysis was conducted to investigate determinants affecting adherence. RESULTS 398 DOAC users completed the questionnaire (mean age 70.6 ± 9.2years). Approximately one in four patients had suboptimal adherence (MMAS-8 < 8). Multivariable analysis showed that patients who felt to have received conflicting information about the treatment, patients with higher educational level and patients who were not sufficiently involved in the treatment choice had a higher odds of suboptimal adherence. CONCLUSION DOAC adherence was suboptimal. Conflicting information received from different healthcare providers (HCPs), lack of shared decision making and the patients' educational level were determinants negatively affecting DOAC adherence. PRACTICE IMPLICATIONS Efforts towards identifying suboptimally adherent DOAC patients are needed since they are at higher risk to develop thromboembolic events. Adherence counselling should be systematically and repeatedly encouraged and shared decision making should become more mainstream. Moreover, reinforced education of both patients and HCPs combined with interprofessional collaboration are potential solutions to prevent knowledge gaps and communication of conflicting information.
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Affiliation(s)
- Souad Moudallel
- Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Centre for Pharmaceutical Research (CePhar), Brussels, Belgium; Department of Clinical Pharmacology and Pharmacotherapy, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium.
| | - Bart J F van den Bemt
- Department of Rheumatology and Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Hanneke Zwikker
- Dutch Institute for Rational Use of Medicine (IVM), Utrecht, the Netherlands
| | - Anne de Veer
- Department of Cardiology, St-Antonius Hospital, Nieuwegein, the Netherlands
| | - Silas Rydant
- Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Centre for Pharmaceutical Research (CePhar), Brussels, Belgium; KAVA, Royal Pharmaceutical Society of Antwerp, Antwerp, Belgium
| | - Liset van Dijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Stephane Steurbaut
- Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Centre for Pharmaceutical Research (CePhar), Brussels, Belgium; Department of Clinical Pharmacology and Pharmacotherapy, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
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29
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Liu Z, Xie Q, Xiang Q, Zhang H, Mu G, Zhao Z, Hu T, Wu T, Wang N, Zhang J, Qian Y, Zhou S, Wang Z, Jiang J, Zhang Y, Song H, Cui Y. Anti-FXa-IIa activity test in Asian and its potential role for drug adherence evaluation in patients with direct oral anticoagulants: a nationwide multi-center synchronization study. Cardiovasc Diagn Ther 2020; 10:1293-1302. [PMID: 33224753 DOI: 10.21037/cdt-20-564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The data of anti-FXa-IIa activity detection in Asian population is insufficient, and its potential role for drug adherence evaluation in patients with direct oral anticoagulants (DOACs) remains unclear. This study carried out multi-center anti-FXa-IIa activity detection in Asian, aiming to explore its applicability in Asian population and find its role in adherence evaluation. METHODS We assessed patients' self-reported adherence using the Morisky, Green, and Levine Adherence Scale (MGLS) from six hospitals. Plasma samples were collected for peak and trough concentration determination, and anti-FXa-IIa chromogenic assay was conducted using rivaroxaban/dabigatran calibrators and controls. Multivariate logistic regression models, covariate adjustment and spearman's two-tailed test were conducted in the data analysis. This study had been registered in clinical trials (NCT03666962). RESULTS In total, 271 patients taking rivaroxaban (n=149) or dabigatran (n=122) were enrolled. Among the 271 patients assessed by MGLS questionnaire, 188 persons (69.4%) showed high adherence, 77 persons (28.4%) was in intermediate adherence group, and only 6 patients (2.2%) had low adherence. Patients are more adherent dosed once daily of rivaroxaban compared to twice daily of dabigatran: 75.6% vs. 63.6%. Anti-FXa-IIa activity had good linear correlation with routine coagulation indexes (P<0.001), but no significant association was found between drug adherence and anti-FXa-IIa activity (P>0.05). CONCLUSIONS This study confirms that anti-FXa-IIa activity detection based on target drug calibrations can be used as an effective index for pharmacodynamic evaluation in Asian population, but had limited value in drug adherence evaluation for DOACs. As the limited samples, these findings could serve as a hypothesis-generating effort, and should be validated in further studies with larger sample sizes.
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Affiliation(s)
- Zhiyan Liu
- Department of Pharmacy, Peking University First Hospital, Beijing, China.,School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Qiufen Xie
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing, China.,School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Hanxu Zhang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Guangyan Mu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Zinan Zhao
- Department of Pharmacy, Beijing Hospital, Beijing, China
| | - Taotao Hu
- Department of Pharmacy, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Tingting Wu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Na Wang
- Department of Pharmacy, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yan Qian
- Department of Pharmacy, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuang Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Zining Wang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yatong Zhang
- Department of Pharmacy, Beijing Hospital, Beijing, China
| | - Hongtao Song
- Department of Pharmacy, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China.,School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
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30
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McBane RD, Torres Roldan VD, Niven AS, Pruthi RK, Franco PM, Linderbaum JA, Casanegra AI, Oyen LJ, Houghton DE, Marshall AL, Ou NN, Siegel JL, Wysokinski WE, Padrnos LJ, Rivera CE, Flo GL, Shamoun FE, Silvers SM, Nayfeh T, Urtecho M, Shah S, Benkhadra R, Saadi SM, Firwana M, Jawaid T, Amin M, Prokop LJ, Murad MH. Anticoagulation in COVID-19: A Systematic Review, Meta-analysis, and Rapid Guidance From Mayo Clinic. Mayo Clin Proc 2020; 95:2467-2486. [PMID: 33153635 PMCID: PMC7458092 DOI: 10.1016/j.mayocp.2020.08.030] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/04/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
A higher risk of thrombosis has been described as a prominent feature of coronavirus disease 2019 (COVID-19). This systematic review synthesizes current data on thrombosis risk, prognostic implications, and anticoagulation effects in COVID-19. We included 37 studies from 4070 unique citations. Meta-analysis was performed when feasible. Coagulopathy and thrombotic events were frequent among patients with COVID-19 and further increased in those with more severe forms of the disease. We also present guidance on the prevention and management of thrombosis from a multidisciplinary panel of specialists from Mayo Clinic. The current certainty of evidence is generally very low and continues to evolve.
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Key Words
- aptt, activated thromboplastin time
- covid-19, coronavirus disease 2019
- dic, disseminated intravascular coagulation
- doac, direct oral anticoagulant
- dvt, deep venous thrombosis
- icu, intensive care unit
- lmwh, low-molecular-weight heparin
- or, odds ratio
- pe, pulmonary embolism
- pt, prothrombin time
- sars-cov, severe acute respiratory syndrome coronavirus
- sc, subcutaneously
- vte, venous thromboembolism
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Affiliation(s)
- Robert D McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Victor D Torres Roldan
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Alexander S Niven
- Division of Pulmonary and Critical Care, Center for Sleep Medicine, Mayo Clinic, Rochester, MN
| | - Rajiv K Pruthi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Ana I Casanegra
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Lance J Oyen
- Department of Pharmacy, Mayo Clinic, Rochester, MN
| | - Damon E Houghton
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ariela L Marshall
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Division of Hematology, Mayo Clinic, Rochester, MN
| | - Narith N Ou
- Department of Pharmacy, Mayo Clinic, Rochester, MN
| | | | - Waldemar E Wysokinski
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Candido E Rivera
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Gayle L Flo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Fadi E Shamoun
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ
| | - Scott M Silvers
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL
| | - Tarek Nayfeh
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Meritxell Urtecho
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Sahrish Shah
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Raed Benkhadra
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Samer Mohir Saadi
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mohammed Firwana
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Tabinda Jawaid
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mustapha Amin
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - M Hassan Murad
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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Packard A, Delate T, Martinez K, Clark NP. Adherence to and persistence with direct oral anticoagulant therapy among patients with new onset venous thromboembolism receiving extended anticoagulant therapy and followed by a centralized anticoagulation service. Thromb Res 2020; 193:40-44. [DOI: 10.1016/j.thromres.2020.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
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Marchetti G, Bertaglia E, Camerini A, De Angelis G, Filippucci L, Maggi A, Marra S, Racani C, Serrati C. Clinical Discussions in Antithrombotic Therapy Management : A Delphi Consensus Panel. J Atr Fibrillation 2020; 12:2159. [PMID: 32435350 DOI: 10.4022/jafib.2159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/22/2019] [Accepted: 11/30/2019] [Indexed: 11/10/2022]
Abstract
For some years now, direct-acting oral anticoagulants (DOACs) have entered the clinical practice for stroke prevention in non-valvular atrial fibrillation (NVAF) or prevention and treatment of venous thromboembolism (VTE). However, there is uncertainty on DOAC use in some clinical scenarios not fully explored by clinical trials, but commonly encountered in the real world. We report a Delphi Consensus on DOAC use in NVAF and VTE patients. The consensus dealt with 16 main topics: (1) clinical superiority of DOACs compared to VKAs; (2) DOACs as a first-line treatment in patients with AF; (3) therapeutic options for patients undergoing electrical cardioversion; (4) selection of patients suitable for switching from VKAs to DOACs; (5) and (7) role of general practitioners in the follow-up of patients receiving a DOAC; (6) duties of Italian oral anticoagulation therapy centers; (8) role of therapy with DOACs in oncological patients with NVAF; (9) role of DOACs in oncological patients with VTE; (10) methods for administration and therapy compliance for DOACs; (11) drug interactions; (12) safety of low doses of DOACs; (13) therapeutic management of frail patients with NVAF; (14) therapeutic management of NVAF patients with glomerular filtration rate <30 ml/min (15); advantages of DOACs for the treatment of frail patients; (16) limitations on therapeutic use of DOACs. Sixty-two cardiologists from Italy expressed their level of agreement on each statement by using a 5-point Likert scale (1: strongly disagree, 2: disagree, 3: somewhat agree, 4: agree, 5: strongly agree). Namely, votes 1-2 were considered as disagreement while votes 3-5 as agreement. Agreement among the respondents of ≥66% for each statement was considered consensus. A brief discussion about the results for each topic is also reported.
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Affiliation(s)
| | | | | | | | - Lucia Filippucci
- U.O. Cardiologia Riabilitativa e Prevenzione Patologie Cardiovascolari, USL Umbria 1, Perugia
| | - Antonio Maggi
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia
| | | | - Carlo Racani
- Direzione Airport Management, OPR / OAP - Pronto Soccorso, Aeroporti di Roma, Roma
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Comparative effectiveness and safety of oral anticoagulants for atrial fibrillation: A retrospective cohort study. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e28-e44. [PMID: 32320170 DOI: 10.15586/jptcp.v27i2.662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/19/2020] [Indexed: 11/18/2022]
Abstract
Oral anticoagulants (OACs) are high-priority medications, frequently used with clinically important benefit and serious harm. Our objective was to compare the safety and effectiveness of direct-acting oral anticoagulants (DOACs) versus warfarin in a population where anticoagulation management and DOACs were readily available. A retrospective cohort study of all adults living in British Columbia with a diagnosis of atrial fibrillation and a first prescription for an OAC was conducted. Co-primary outcomes were ischemic stroke and systemic embolism, and major bleeding. Secondary outcomes included a net clinical outcome composite and analysis of discontinuation, switching, and key subgroups. We estimated the effects of treatment using time-to-event models with high-dimensional propensity score adjustment to control confounding. After adjustment for prescribing bias, a cohort (n = 20,113, 43.8% female, mean age 72.4 years) with a mean follow-up of 18.1 months showed that patients taking warfarin tended to be poorer, sicker, and less likely to have a cardiologist prescriber. Outcome event rates were not significantly different for DOACs compared to warfarin [adjusted rate ratio of 1.15 (0.91, 1.46) for systemic embolism, 0.94 (0.82, 1.08) for major bleeding, and 0.98 (0.90, 1.06) for net clinical outcome]. Only the effect of age on net clinical outcome met our strict criteria for predicting which group might be superior. Switch of drug class was associated with increased risk of events (p < 0.003). In this population, we found no difference in important clinical outcomes between warfarin and DOACs. Switching compared to not switching was associated with harm.
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Management of suspected and confirmed recurrent venous thrombosis while on anticoagulant therapy. What next? Thromb Res 2019; 180:105-109. [DOI: 10.1016/j.thromres.2019.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/23/2022]
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Afzal SK, Hasan SS, Babar ZUD. A systematic review of patient-reported outcomes associated with the use of direct-acting oral anticoagulants. Br J Clin Pharmacol 2019; 85:2652-2667. [PMID: 31077431 DOI: 10.1111/bcp.13985] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/02/2019] [Accepted: 04/24/2019] [Indexed: 12/26/2022] Open
Abstract
AIMS Patient-reported outcomes (PROs) are a distinctive method of evaluating patient response to health care or treatment. This systematic review aimed to analyse the impact of PROs in patients on direct oral anticoagulant (DOAC) treatment, prescribed for any indication (e.g. venous thromboembolism treatment or atrial fibrillation) using controlled trials (CT) and real-world observational studies (OS). METHODS A systematic search of articles was conducted according to PRISMA guidelines using databases, with the last update in November 2018. The Cochrane Collaboration tool for assessing bias in randomized CTs and the Newcastle-Ottawa Scale adapted for cross-sectional studies were used. Outcomes evaluated were related to health-related quality of life (HRQoL), satisfaction, adherence and compliance. RESULTS Twenty-one original studies (6 CT, 15 OS) were included. HRQoL was assessed by 6 (1 CT, 5 OS) studies and reported that HRQoL scores were similar in patients on DOACs and warfarin. Patients prescribed DOACs presented higher HRQoL scores which were attributed to lack of intense monitoring required compared with warfarin but this was not statistically significant. The majority of studies (5 CT, 9 OS) investigated patient-reported satisfaction, indicating greater satisfaction with DOACs with significantly lower burden and increased benefit scores for patients on DOACs. Patient-reported expectations, compliance and adherence were similar for patients on DOACs and warfarin. CONCLUSION Patients appear to prefer treatment with DOACs vs warfarin. This is shown by the higher quality of life, satisfaction and adherence described in the studies. However, heterogeneity in the analysed studies does not allow firm conclusions.
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Affiliation(s)
| | - Syed Shahzad Hasan
- University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, UK
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Adequate Adherence to Direct Oral Anticoagulant is Associated with Reduced Ischemic Stroke Severity in Patients with Atrial Fibrillation. J Stroke Cerebrovasc Dis 2019; 28:1773-1780. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/02/2018] [Accepted: 09/14/2018] [Indexed: 11/18/2022] Open
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Mohan A, Wanat MA, Abughosh SM. Medication taking behaviors in patients taking warfarin versus direct oral anticoagulants: A systematic review. Expert Rev Cardiovasc Ther 2019; 17:427-434. [PMID: 31100208 DOI: 10.1080/14779072.2019.1620600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: This article aims to compare medication adherence and persistence between warfarin and direct oral anticoagulants (DOACs) and identify reported adherence barriers. As with other chronic illness, medication nonadherence continues to be a problem and appropriate adherence to long-term anticoagulation therapy is needed to improve patient health outcomes and to reduce health expenditure associated with hospitalizations and emergency visits. Areas covered: Warfarin and DOACs such as apixaban, rivaroxaban, edoxaban, and dabigatran have demonstrated effectiveness in the management of atrial fibrillation (AF), deep vein thrombosis (DVT), and pulmonary embolism (PE). Adherence and long-term persistence to oral anticoagulants is highly associated with reduced adverse events. A systematic literature search from 2013 to 2018 examined the primary outcome of adherence and persistence. Expert opinion: Currently, warfarin is less preferred over DOACs due to associated complications like narrow therapeutic window, inconvenience, and increased risk of adverse events. At the same time, the lack of monitoring with DOACs in combination with cost issues may negatively impact medication adherence. Examining adherence barriers identified in the literature is the first step to designing effective interventions aimed at enhancing adherence in this high-risk population.
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Affiliation(s)
- Anjana Mohan
- a Department of Pharmaceutical Outcomes and Policy , University of Houston College of Pharmacy , Houston , TX , USA
| | - Matthew A Wanat
- b Department of Pharmacy Practice and Translational Research , University of Houston College of Pharmacy , Houston , TX , USA
| | - Susan M Abughosh
- a Department of Pharmaceutical Outcomes and Policy , University of Houston College of Pharmacy , Houston , TX , USA
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Patient-reported Adherence to Adjuvant Aromatase Inhibitor Therapy Using the Morisky Medication Adherence Scale: An Evaluation of Predictors. Am J Clin Oncol 2019; 41:508-512. [PMID: 27322700 DOI: 10.1097/coc.0000000000000314] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Endocrine therapy is part of standard adjuvant therapy for patients with hormone receptor-positive breast cancer and has been shown to improve recurrence-free and overall survival. However, adherence to endocrine therapy is suboptimal and is difficult to measure. In this study we evaluate the feasibility of using the Morisky Medication Adherence Scale (MMAS) to assess patient adherence to aromatase inhibitor (AI) therapy. METHODS Patients with stage 1 to 3, hormone receptor-positive breast cancer receiving adjuvant AI therapy were prospectively enrolled on an Institutional Review Board approved protocol. The MMAS questionnaire was administered to each patient and adherence was measured. Information on duration of AI therapy, patient and tumor characteristics, and treatment was collected. A multivariable logit model approach was utilized to evaluate potential barriers to adherence. RESULTS Between 2011 and 2014, 100 patients were enrolled. The distribution of adherence levels was 13% low, 37% medium, and 50% high. High adherence was reported more frequently in white women (58%), patients with stage 2 and 3 disease (54%), and patients who did not receive chemotherapy (62%). Multivariable analysis demonstrated that higher adherence was more likely in white women compared with African American women (estimated odds ratio=2.8). CONCLUSIONS Using the MMAS, only 50% of women with stage 1 to 3 breast cancer reported high adherence to AI therapy, consistent with other reports showing suboptimal adherence to adjuvant endocrine therapy. The MMAS allows for the rapid assessment of adherence to oral adjuvant endocrine therapy and is valuable in a busy clinical setting.
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Fernandes L, Sargento-Freitas J, Milner J, Silva A, Novo A, Gonçalves T, Marinho AV, Pego GM, Cunha L, António N. Ischemic stroke in patients previously anticoagulated for non-valvular atrial fibrillation: Why does it happen? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Fernandes L, Sargento‐Freitas J, Milner J, Silva A, Novo A, Gonçalves T, Marinho AV, Mariano Pego G, Cunha L, António N. Acidente vascular cerebral isquémico em doentes previamente anticoagulados por fibrilhação auricular não valvular: por que acontece? Rev Port Cardiol 2019; 38:117-124. [DOI: 10.1016/j.repc.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/21/2018] [Accepted: 06/03/2018] [Indexed: 10/27/2022] Open
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Rossi AP, Facchinetti R, Ferrari E, Nori N, Sant S, Masciocchi E, Zoico E, Fantin F, Mazzali G, Zamboni M. Predictors of self-reported adherence to direct oral anticoagulation in a population of elderly men and women with non-valvular atrial fibrillation. J Thromb Thrombolysis 2019; 46:139-144. [PMID: 29761426 DOI: 10.1007/s11239-018-1679-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There is a general lack of studies evaluating medication adherence with self-report scales for elderly patients in treatment with direct oral anticoagulants (DOACs). The aim of the study was to assess the degree of adherence to DOAC therapy in a population of elderly outpatients aged 65 years or older affected by non-valvular atrial fibrillation (NVAF), using the 4-item Morisky Medication Adherence Scale, and to identify potential factors, including the geriatric multidimensional evaluation, which can affect adherence in the study population. A total of 103 subjects, anticoagulated with DOACs for NVAF in primary or secondary prevention, were eligible; 76 showed adequate adhesion to anticoagulant therapy, while 27 showed inadequate adherence. Participants underwent biochemical assessment and Morisky Scale, Instrumental Activities of Daily Living, CHA2DS2-VASc, HAS-BLED, mental status and nutritional evaluations were performed. 2% of subjects assumed Dabigatran at low dose, while 7.8% at standard dose, 9.7% assumed low-dose of Rivaroxaban and 30.1% at standard dose, 6.8% assumed Apixaban at low dose and 39.7% at standard dose, and finally 1% assumed Edoxaban at low dose and 2.9% at standard dose. Most subjects took the DOACs without help (80.6%), while 16 subjects were helped by a family member (15.5%) and 4 were assisted by a caregiver (3.9%). Binary logistic regression considered inappropriate adherence as a dependent variable, while age, male sex, polypharmacotherapy, cognitive decay, caregiver help for therapy assumption, duration of DOAC therapy and double daily administration were considered as independent variables. The double daily administration was an independent factor, determining inappropriate adherence with an OR of 2.88 (p = 0.048, CI 1.003-8.286).
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Affiliation(s)
- Andrea P Rossi
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy. .,Healthy Aging Center Verona, Verona, Italy.
| | | | - Elena Ferrari
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Nicole Nori
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Selena Sant
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Elena Masciocchi
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Elena Zoico
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Francesco Fantin
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Gloria Mazzali
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
| | - Mauro Zamboni
- Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.,Healthy Aging Center Verona, Verona, Italy
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Lunde ED, Nielsen PB, Riahi S, Larsen TB, Lip GYH, Fonager K, Larsen ML, Joensen AM. Associations between socioeconomic status, atrial fibrillation, and outcomes: a systematic review. Expert Rev Cardiovasc Ther 2018; 16:857-873. [PMID: 30293472 DOI: 10.1080/14779072.2018.1533118] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a growing epidemic and evidence of a relationship to socioeconomic status (SES) is inconsistent. We aimed to summarize the literature about SES and AF and defined two objectives: (1) To examine the association between SES and the risk of AF; (2) To examine the association between SES and AF-related outcomes in an AF-population. METHODS We performed a separate search for each objective in Ovid-MEDLINE and Ovid-Embase. For objective 1, the population included was healthy participants and outcome of interest was AF. For objective 2, the population included were patients with AF and outcome of interest was mortality, treatment, ablation for AF, knowledge about AF, and morbidity. RESULTS For objective 1, 12 studies were included. No consistent pattern for an association between SES and the risk of AF was discovered. For objective 2, 39 studies comprising 42 outcomes were included. The majority of studies showed an association between low SES and increased mortality and morbidity. CONCLUSION Low SES was associated with poorer outcomes when AF was present. These findings may imply that health-care professionals and policy interventions should focus on the promotion of AF-education and management among patients with AF and low SES.
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Affiliation(s)
| | - Peter Brønnum Nielsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
| | - Sam Riahi
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
| | - Torben Bjerregaard Larsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
| | - Gregory Y H Lip
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
- e Institute of Cardiovascular Sciences , University of Birmingham , UK
| | - Kirsten Fonager
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- f Department of Social Medicine , Aalborg University Hospital , Aalborg , Denmark
| | - Mogens Lytken Larsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- g Danish Centre of Inequality in Health, Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
| | - Albert Marni Joensen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
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Ingrasciotta Y, Crisafulli S, Pizzimenti V, Marcianò I, Mancuso A, Andò G, Corrao S, Capranzano P, Trifirò G. Pharmacokinetics of new oral anticoagulants: implications for use in routine care. Expert Opin Drug Metab Toxicol 2018; 14:1057-1069. [PMID: 30277082 DOI: 10.1080/17425255.2018.1530213] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Since 2008, new oral anticoagulants (NOACs) have been approved for the prevention of venous thromboembolism (VTE) in patients receiving hip or knee replacement surgery, prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF), treatment of deep vein thrombosis (DVT), and pulmonary embolism (PE). Premarketing randomized clinical trials (RCTs) of NOACs demonstrated their non-inferiority in terms of efficacy vs. warfarin (traditional oral anticoagulant - TOA), with lower risk of serious adverse drug reactions, especially cerebral hemorrhages. In clinical practice, pharmacokinetic aspects of NOACs have to be carefully taken into account to optimize the benefit-risk profile of these drugs. Areas covered: An overview of major issues related to pharmacokinetics of NOACs, such as drug-drug interactions, over- and underdosage in special populations (e.g. elderly, underweight, and chronic kidney disease patients), and impact on adherence and persistence to NOACs therapy and ultimately clinical outcomes in real-world setting, is provided. Expert opinion: NOACs have been proven to be a better option than traditional anticoagulants due to better tolerability and ease of use. However, given specific pharmacokinetic characteristics, NOAC therapy has to be carefully tailored and monitored in relation to patient characteristics with the final goal of maximizing benefits and minimizing risks.
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Affiliation(s)
- Ylenia Ingrasciotta
- a Department of Biomedical and Dental Sciences and Morpho-functional Imaging , University of Messina , Messina , Italy
| | - Salvatore Crisafulli
- a Department of Biomedical and Dental Sciences and Morpho-functional Imaging , University of Messina , Messina , Italy
| | - Valeria Pizzimenti
- b Unit of Clinical Pharmacology , A.O.U. Policlinico "G. Martino" , Messina , Italy
| | - Ilaria Marcianò
- b Unit of Clinical Pharmacology , A.O.U. Policlinico "G. Martino" , Messina , Italy
| | - Anna Mancuso
- a Department of Biomedical and Dental Sciences and Morpho-functional Imaging , University of Messina , Messina , Italy
| | - Giuseppe Andò
- c Department of Clinical and Experimental Medicine, Section of Cardiology , University of Messina , Messina , Italy
| | - Salvatore Corrao
- d Department of Internal Medicine , National Relevance and High Specialization Hospital Trust , Palermo , Italy
| | - Piera Capranzano
- e Cardiovascular Department , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Gianluca Trifirò
- a Department of Biomedical and Dental Sciences and Morpho-functional Imaging , University of Messina , Messina , Italy.,b Unit of Clinical Pharmacology , A.O.U. Policlinico "G. Martino" , Messina , Italy
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Miyazaki M, Nakashima A, Nakamura Y, Sakamoto Y, Matsuo K, Goto M, Uchiyama M, Okamura K, Mitsutake R, Urata H, Kamimura H, Imakyure O. Association between medication adherence and illness perceptions in atrial fibrillation patients treated with direct oral anticoagulants: An observational cross-sectional pilot study. PLoS One 2018; 13:e0204814. [PMID: 30265710 PMCID: PMC6161891 DOI: 10.1371/journal.pone.0204814] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/15/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the association between medication adherence and illness perceptions, and to explore the factors associated with poor medication adherence in atrial fibrillation (AF) patients receiving direct oral anticoagulants (DOACs) in a real-world clinical setting. METHODS An observational cross-sectional pilot study was conducted at a single Japanese university hospital. One hundred and twenty-nine patients who were diagnosed with AF and who were taking DOACs were recruited from outpatients between January 4th and April 25th, 2017. We evaluated medication adherence to DOACs using the Morisky Medication Adherence Scale-8 (MMAS-8) and illness perceptions using the Brief Illness Perception Questionnaire (BIPQ). The patients' characteristics and clinical data were collected from electronic medical records. RESULTS Ninety-nine (76.7%) patients (male, n = 74; mean age, 71.4±9.8 years) participated in this study. According to the MMAS-8, 21 (21.2%) of the patients were classified into the poor adherence group (MMAS-8 score of <6), and 78 (78.8%) were classified into the good adherence group (MMAS-8 score of 6-8). A multivariate logistic regression analysis revealed that age (per year, odds ratio [OR] 0.912, 95% confidence interval [CI] 0.853-0.965, p = 0.001), a history of warfarin use (OR 0.181, 95% CI 0.033-0.764, p = 0.019), duration of DOAC exposure (per 100 days, OR 1.245, 95% CI 1.084-1.460, p = 0.001), and the BIPQ emotional response score (per 1 point, OR 1.235, 95% CI 1.015-1.527, p = 0.035) were significantly associated with poor medication adherence in AF patients receiving DOACs. CONCLUSION Poor medication adherence to DOACs was strongly associated with a stronger emotional response (i.e. stronger feelings of anger, anxiety, and depression), as well as younger age, the absence of a history of warfarin treatment, and longer DOAC exposure. Further evaluation of the factors associated with medication adherence in AF patients and the development and execution of strategies for improving poor adherence are warranted in the real-world clinical setting.
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Affiliation(s)
- Motoyasu Miyazaki
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akio Nakashima
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yuya Sakamoto
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Koichi Matsuo
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Miwa Goto
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Masanobu Uchiyama
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Keisuke Okamura
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Ryoko Mitsutake
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | | | - Osamu Imakyure
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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Smet L, Heggermont WA, Goossens E, Eeckloo K, Vander Stichele R, De Potter T, De Backer T. Adherence, knowledge, and perception about oral anticoagulants in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation. J Adv Nurs 2018; 74:2577-2587. [PMID: 29944735 DOI: 10.1111/jan.13780] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 04/17/2018] [Accepted: 05/01/2018] [Indexed: 01/08/2023]
Abstract
AIMS This study aimed to: (a) determine adherence rates to oral anticoagulants in atrial fibrillation patients with a high risk for thromboembolic events postradiofrequency ablation; (b) evaluate patients' knowledge and perceptions towards oral anticoagulants; and (c) explore the impact of patients' knowledge and perceptions on treatment adherence. BACKGROUND Atrial fibrillation is a common arrhythmia associated with an increased risk of developing thromboembolic events such as stroke. Although adherence to oral anticoagulants is crucial to prevent such complications, the relationship between adherence, knowledge and patient perceptions is poorly understood in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation. DESIGN A cross-sectional observational survey study was performed in a single centre. METHODS The levels of adherence, knowledge, and perception towards oral anticoagulants were assessed using the 8-item Morisky Medication Adherence Scale, Knowledge of Oral Anticoagulation Tool, Perception of Anticoagulant Treatment Questionnaire and Benefit-Risk Perception Tool, respectively. Results from these self-reported tools were analysed descriptively. A multivariable binary logistic regression model was used to identify factors associated with levels of adequate adherence. RESULTS Adequate treatment adherence was found in three-quarters of patients. The total mean knowledge score was low. Participants expressed high ease of use and low burden of treatment. Higher total knowledge and satisfaction scores were significant factors associated with higher levels of adherence. CONCLUSION There remains a huge unmet need to follow-up and educate patients with atrial fibrillation, focusing on good knowledge and correct perception of the advantages and disadvantages of oral anticoagulants. Our results suggest that increased knowledge and satisfaction rates might have a positive impact on adherence to oral anticoagulants.
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Affiliation(s)
- Lily Smet
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Cardiology, Cardiovascular Research Center Aalst, OLV Hospital Aalst, Aalst, Belgium
| | - Ward A Heggermont
- Department of Cardiology, Cardiovascular Research Center Aalst, OLV Hospital Aalst, Aalst, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Kristof Eeckloo
- Department of Public Health, Ghent University, Ghent, Belgium.,University Hospital Ghent, Ghent, Belgium
| | | | - Tom De Potter
- Department of Cardiology, Cardiovascular Research Center Aalst, OLV Hospital Aalst, Aalst, Belgium
| | - Tine De Backer
- Department of Public Health, Ghent University, Ghent, Belgium.,University Hospital Ghent, Ghent, Belgium.,Department of Cardiovascular Diseases, University Hospital Ghent, Ghent, Belgium
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Gavín Sebastián O, Izuzquiza Fernández M, Martínez Fernández R, Palomera Bernal L. Anticoagulation with rivaroxaban in a hematology unit: clinical profile, events and discontinuation rates in real-life patients with nonvalvular atrial fibrillation. Future Cardiol 2018; 14:25-30. [PMID: 29848092 DOI: 10.2217/fca-2018-0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To assess the clinical profile and thromboembolic and bleeding events in patients with nonvalvular atrial fibrillation (AF) who were attended in a hematology unit. METHODS Retrospective study of AF patients that started treatment with rivaroxaban between February 2012 and June 2016 in a hematology unit from a tertiary hospital in Spain. RESULTS Overall, 243 patients (mean age 78.4 ± 10.1 years; 47.5% women, CHA2DS2-VASc 3.7 ± 1.5) were included. After a mean follow-up of 16.5 ± 12.7 months, rivaroxaban was discontinued in only 2.4% of patients. During the follow-up, seven (2.0 events/100 patient-years) patients had a thromboembolic event and six patients (1.7 events/100 patient-years) a major bleeding. CONCLUSION Rivaroxaban was effective and safe among AF patients treated in a hematology unit, with very low discontinuation rates.
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Affiliation(s)
- Olga Gavín Sebastián
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - Luis Palomera Bernal
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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47
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Emren SV, Zoghi M, Berilgen R, Özdemir İH, Çelik O, Çetin N, Enhoş A, Köseoğlu C, Akyüz A, Doğan V, Levent F, Dereli Y, Doğan T, Başaran Ö, Karaca I, Karaca Ö, Otlu YÖ, Özmen Ç, Coşar S, Sümerkan M, Gürsul E, İnci S, Onrat E, Ergene O. Safety of once- or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study. Bosn J Basic Med Sci 2018; 18:185-190. [PMID: 28968197 DOI: 10.17305/bjbms.2017.2279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 02/05/2023] Open
Abstract
Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once- or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1:1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 ± 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.
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Affiliation(s)
- Sadık Volkan Emren
- Department of Cardiology, Faculty of Medicine, Katip Celebi University, Izmir, Turkey.
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48
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Liu MY, Ballard DW, Huang J, Rauchwerger AS, Reed ME, Bouvet SC, Vinson DR. Acute Pulmonary Embolism in Emergency Department Patients Despite Therapeutic Anticoagulation. West J Emerg Med 2018; 19:510-516. [PMID: 29760849 PMCID: PMC5942018 DOI: 10.5811/westjem.2018.1.35586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/16/2017] [Accepted: 01/07/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Emergency department (ED) patients with acute pulmonary embolism (PE) despite therapeutic anticoagulation at the time of diagnosis are uncommonly encountered and present a diagnostic and management challenge. Their characterization and outcomes are poorly described. We sought to describe the prevalence and characteristics of therapeutically anticoagulated patients among a population of patients with acute PE in a community setting and to describe treatment changes and 30-day outcomes. Methods From a large retrospective cohort of adults with acute, objectively-confirmed PE across 21 EDs between 01/2013 and 04/2015, we identified patients who arrived on direct oral or injectable anticoagulants, or warfarin with an initial ED international normalized ratio (INR) value ≥2.0. Patients were excluded from the larger cohort if they had received a diagnosis of venous thromboembolism (VTE) in the prior 30 days. We gathered demographic and clinical variables from electronic health records and structured manual chart review. We report discharge anticoagulation regimens and major 30-day adverse outcomes. Results Among 2,996 PE patients, 36 (1.2%) met study criteria. Mean age was 63 years. Eleven patients (31%) had active cancer and 25 (69%) were high risk on the PE Severity Index (Classes III–V), comparable to the larger cohort (p>0.1). Reasons for pre-arrival anticoagulation were VTE treatment or prevention (n=21), and atrial fibrillation or flutter (n=15). All patients arrived on warfarin and one was also on enoxaparin: 32 had a therapeutic INR (2.0–3.0) and four had a supratherapeutic INR (>3.0). Fifteen patients (42%) had at least one subtherapeutic INR (<2.0) in the 14 days preceding their diagnostic visit. Two patients died during hospitalization. Of the 34 ultimately discharged, 22 underwent a change in anticoagulation drug or dosing, 19 of whom received injectables, either to replace or to supplement warfarin. Four patients also received inferior vena cava filters. Thirty-day outcomes included one major hemorrhage and one additional death. No patients experienced recurrent or worsening VTE. Conclusion We found a low prevalence of therapeutic anticoagulation at the time of acute PE diagnosis. Most patients with breakthrough PE underwent a change in therapy, though management varied widely. Subtherapeutic anticoagulation levels in the preceding weeks were common and support the importance of anticoagulation adherence.
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Affiliation(s)
- Michelle Y Liu
- Kaiser Permanente, Division of Research, Oakland, California
| | - Dustin W Ballard
- Kaiser Permanente, Division of Research, Oakland, California.,Kaiser Permanente, San Rafael Medical Center, Department of Emergency Medicine, San Rafael, California
| | - Jie Huang
- Kaiser Permanente, Division of Research, Oakland, California
| | | | - Mary E Reed
- Kaiser Permanente, Division of Research, Oakland, California
| | - Sean C Bouvet
- Kaiser Permanente, Walnut Creek Medical Center, Department of Emergency Medicine, Walnut Creek, California
| | - David R Vinson
- Kaiser Permanente, Division of Research, Oakland, California.,Kaiser Permanente, Sacramento Medical Center, Department of Emergency Medicine, Sacramento, California
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49
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Obamiro KO, Chalmers L, Lee K, Bereznicki BJ, Bereznicki LR. Adherence to Oral Anticoagulants in Atrial Fibrillation: An Australian Survey. J Cardiovasc Pharmacol Ther 2018; 23:337-343. [DOI: 10.1177/1074248418770201] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: The aim of this study was to investigate the proportion of patients who have suboptimal adherence to oral anticoagulant (OAC), identify the predictors of adherence, and determine whether patient-related factors vary across adherence levels in Australia. Methods: Respondents were recruited for an online survey using Facebook. Survey instruments included the Morisky Medication Adherence Scale, the Anticoagulation Knowledge Tool, the Perception of Anticoagulant Treatment Questionnaires, and a modified Cancer Information Overload scale. Predictors of medication adherence were identified using ordinal regression analysis. Results: Of the 386 responses eligible for analysis, only 54.9% reported a high level of adherence. Participants aged 65 years or younger were less likely to have high adherence compared to older participants (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.33-0.88; P = .013), while females were more likely to be highly adherent compared to males (OR, 1.69; 95% CI, 1.08-2.64; P = .023). The analyses showed that age, gender, treatment satisfaction, information overload, concerns about making mistake when taking OACs, and cost of medication were significant predictors of adherence. Conclusion: Self-reported suboptimal adherence to OAC is common among patients with atrial fibrillation. A focus on supporting people who are at higher risk of suboptimal adherence is needed to maximize the benefit of OAC therapy in this population.
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Affiliation(s)
- Kehinde O. Obamiro
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leanne Chalmers
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Kenneth Lee
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Bonnie J. Bereznicki
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Luke R. Bereznicki
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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50
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Emren SV, Şenöz O, Bilgin M, Beton O, Aslan A, Taşkin U, Açiksari G, Asarcikli LD, Çakir H, Bekar L, Bolat İ, Yayla Ç, Çelebi B, Dalgiç O, Çelik O, Şafak Ö, Akyel S, Güngör H, Düzel B, Zoghi M. Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR. Clin Appl Thromb Hemost 2018; 24:525-531. [PMID: 28301907 PMCID: PMC6714660 DOI: 10.1177/1076029617693940] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 ± 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P = .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.
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Affiliation(s)
- Sadık Volkan Emren
- Department of Cardiology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Oktay Şenöz
- Department of Cardiology, Artvin State Hospital, Artvin, Turkey
| | - Murat Bilgin
- Department of Cardiology, Ankara Dışkapı Research and Education Hospital, Ankara, Turkey
| | - Osman Beton
- Department of Cardiology, Sivas Cumhuriyet University, Sivas, Turkey
| | - Abdullah Aslan
- Department of Cardiology, Dokuz Eylül University, Izmir, Turkey
| | - Uğur Taşkin
- Department of Cardiology, Akşehir State Hospital, Konya, Turkey
| | - Gönül Açiksari
- Department of Cardiology, Istanbul İstinye State Hospital, Istanbul, Turkey
| | - Lale Dinç Asarcikli
- Department of Cardiology, Ankara Dışkapı Research and Education Hospital, Ankara, Turkey
| | - Hakan Çakir
- Department of Cardiology, Darıca Farabi State Hospital, Kocaeli, Turkey
| | - Lütfü Bekar
- Department of Cardiology, Hitit University, Çorum, Turkey
| | - İsmail Bolat
- Department of Cardiology, Fethiye State Hospital, Muğla, Turkey
| | - Çağrı Yayla
- Department of Cardiology, Ankara Yüksek İhtisas Research and Education Hospital, Ankara, Turkey
| | - Barış Çelebi
- Department of Cardiology, Silifke State Hospital, Mersin, Turkey
| | - Onur Dalgiç
- Department of Cardiology, Karşıyaka State Hospital, İzmir, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, School of Medicine, Hitit University, Çorum, Turkey
| | - Özgen Şafak
- Department of Cardiology, Burdur State Hospital, Burdur, Turkey
| | - Serdar Akyel
- Department of Cardiology, Münif İslamoğlu State Hospital, Kastamonu, Turkey
| | - Hasan Güngör
- Department of Cardiology, Aydın University School of Medicine, Aydın, Turkey
| | - Barış Düzel
- Department of Cardiology, Mersin State Hospital, Mersin, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, Ege University, Izmir, Turkey
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