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Azzoug C, Nuémi G, Menu D, De Maistre E, Boulin M, Putot A, Manckoundia P. Direct Oral Anticoagulants versus Vitamin K Antagonists in Individuals Aged 80 Years and Older: An Overview in 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1448. [PMID: 36674204 PMCID: PMC9859400 DOI: 10.3390/ijerph20021448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Two main types of oral anticoagulants are available in France: vitamin K antagonists (VKA) and, more recently, direct oral anticoagulants (DOAC). The benefit−risk profile appears to be favorable for DOAC, which is as effective as VKA but safer (fewer cases of severe and cerebral bleeding). In a study in 2017, we observed that older adults did not seem to receive the same modalities of oral anticoagulants as younger individuals for various reasons. To assess anticoagulation prescribing practices over time, we repeated this cross-sectional study by comparing very old individuals taking DOAC to those taking VKA. Ambulatory individuals aged 80 years and older were included. They were affiliated with the Mutualité Sociale Agricole of Burgundy and were refunded for a medical prescription of oral anticoagulation in March 2021. The demographic characteristics, registered chronic diseases (RCD), number and types of prescribed drugs, and mortality of the DOAC group and the VKA group were compared. A total of 4275 subjects were included in the study: 67.44% (2883) received DOAC and 32.56% (1392) received VKA. The two groups were similar in age. In the DOAC group, there were more women (54.98% vs. 46.98%) (p < 0.001), fewer RCD (91.47% vs. 93.68%) (p = 0.014), and lower rates of venous thromboembolism (2.53% vs. 6.75%) (p < 0.001), severe heart failure (56.50% vs. 68.03%) (p < 0.001), and severe kidney diseases (1.38% vs. 3.59%) (p < 0.001), but there were more subjects with Alzheimer’s disease (7.49% vs. 4.31%) (p = 0.001). Individuals in the DOAC group had fewer prescriptions of furosemide (48.53% vs. 55.75%) (p < 0.001) and fibrates (2.32% vs. 3.88%) (p = 0.044). They also had more prescriptions of proton pump inhibitors (43.95% vs. 39.44%) (p = 0.006) and antirheumatics (1.60% vs. 0.65%) (p = 0.009) than those in the VKA group. There was no difference in mortality. This study revealed that prescribing practices for DOAC have changed over time.
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Affiliation(s)
- Chana Azzoug
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France
| | - Gilles Nuémi
- Medical Information Department, University Hospital, 21079 Dijon, France
| | - Didier Menu
- “Mutualité Sociale Agricole” of Burgundy Franche Comté, 21000 Dijon, France
| | | | - Mathieu Boulin
- Pharmacy Department, University Hospital, 21079 Dijon, France
| | - Alain Putot
- Department of Internal Medicine and Infectious Diseases, Pays du Mont Blanc Hospital, 74700 Sallanches, France
- Physiopathologie et Épidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy, 21000 Dijon, France
| | - Patrick Manckoundia
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France
- INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy, 21000 Dijon, France
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2
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Salmasi S, Safari A, Kapanen A, Adelakun A, Kwan L, MacGillivray J, Andrade JG, Deyell MW, Loewen P. Oral anticoagulant adherence and switching in patients with atrial fibrillation: A prospective observational study. Res Social Adm Pharm 2022; 18:3920-3928. [PMID: 35753963 DOI: 10.1016/j.sapharm.2022.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Adherence to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) is important in preventing stroke. The dominance of retrospective studies using administrative data has led to a lack of data on psychosocial determinants of adherence and prevented comparison of adherence between OAC drug classes. OAC switching is another aspect of adherence that is unexplored. METHODS A prospective design was utilized to measure AF patients' self-reported adherence and OAC switching, and to identify their clinical, demographic, and psychosocial determinants. Participants were recruited from specialized AF clinics in Canada and followed for up to 2 years. Data were collected via telephone every 3-4 months using a structured survey. Adherence was measured using the Morisky Medication Adherence scale (©MMAS-8). RESULTS The included participants (N = 306) were followed for a median follow up time of 14.1 months and had an average of 3.2(SD 1.4) study visits. The mean self-reported adherence on the ©MMAS-8 was 7.28(SD 0.71) for patients receiving care at specialized AF clinics. Older age, experiencing a bleed, and higher satisfaction with the burden of medications were significantly associated with higher adherence. Drug class did not have any significant impact on adherence. 7.8% of the cohort experienced a switch with most of them being from warfarin to DOAC. Taking warfarin as the index medication, experiencing a bleed and older age were significantly associated with higher odds of switching. CONCLUSION Patients with AF reported high adherence to their OAC therapy however being on DOAC may not translate to better adherence compared to VKA. Improving satisfaction with the burden of therapy is important in improving adherence.
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Affiliation(s)
- Shahrzad Salmasi
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Abdollah Safari
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; Data Analytics, Statistics and Informatics, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Anita Kapanen
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Adenike Adelakun
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Leanne Kwan
- Atrial Fibrillation Clinic, Royal Columbian Hospital, New Westminster, Canada
| | - Jenny MacGillivray
- Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, Canada
| | - Jason G Andrade
- Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, Canada; Division of Cardiology, Faculty of Medicine, The University of British Columbia, Canada; UBC Centre for Cardiovascular Innovation, Vancouver, Canada
| | - Marc W Deyell
- Division of Cardiology, Faculty of Medicine, The University of British Columbia, Canada; UBC Centre for Cardiovascular Innovation, Vancouver, Canada; Atrial Fibrillation Clinic, St. Paul's Hospital, Vancouver, Canada
| | - Peter Loewen
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; UBC Centre for Cardiovascular Innovation, Vancouver, Canada.
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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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Ostrowka C, Journeau L, Plaisance L, Poenou G, Mecherour SE, Helfer H, Mahé I. Educational diagnosis of patients under oral anticoagulant therapy: Development of a 4-category patient profiling score based on a retrospective study and prospective analysis. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:184-191. [PMID: 32571558 DOI: 10.1016/j.jdmv.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Oral anticoagulants are used in numerous pathologies and their consumption is growing. However, to prevent their occurrence, their use should be supervised and the patients educated. Patients vary in understanding and compliance. Therefore, it seems necessary to standardize educational diagnosis with a patient profiling score to adapt therapeutic education to the individual patient profile. METHOD A retrospective study based on observation of consecutive patients treated by an oral anticoagulant therapy and involved in a therapeutic education program conducted between October 2014 and December 2015. A 12-item questionnaire distinguished 4 profiles based on the educational diagnosis. In a prospective double-blind study including consecutive patients with an indication to anticoagulants and admitted to the Internal Medicine department of the Louis-Mourier Hospital (AP-HP, University of Paris), the patient's profile defined by a clinician using the questionnaire was compared to the one defined by the Therapeutic Education Leader after standardized educational diagnosis. RESULTS The questionnaire was tested prospectively in 53 patients, 26 of which had also a complete therapeutic education by the TEP leader. In any case, the assessment assisted by the questionnaire succeeded in identifying the patient profile, as determined by the therapeutic education specialist. CONCLUSION The present questionnaire helps identify different patient profiles and therefore standardize educational diagnosis. The perspective is to adapt therapeutic education to individual patient profile, with the objective to improve compliance.
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Affiliation(s)
- C Ostrowka
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France
| | - L Journeau
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France; Paris University, Paris, France
| | - L Plaisance
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France; Paris University, Paris, France
| | - G Poenou
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France; Paris University, Paris, France
| | - S E Mecherour
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France
| | - H Helfer
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France
| | - I Mahé
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France; Paris University, Paris, France; Paris University, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, France; F-CRIN INNOVTE, Saint-Étienne, France.
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5
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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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