Introduction Adherence to warfarin is associated with improved outcome in patients with atrial fibrillation (AF), but the adherence status of patients in rural areas of China is not known. Methods A questionnaire-based study evaluating warfarin adherence of rural residents with AF was carried out in Dongyang, China. Potentially eligible patients were screened and contacted by telephone, and their demographic characteristics were collected. Illness perception was assessed using the Brief Illness Perception Questionnaire (BIPQ), and warfarin adherence was assessed using a Chinese-version adherence scale. Univariate and multivariate analyses were conducted to identify factors associated with unsatisfactory adherence. Results A total of 201 patients (male, n =99; mean age, 70.3±8.12 years) were included, among whom 95 (47.3%) patients showed good adherence and 63 (31.3%) poor adherence. Number of co-dispensed drugs (multivariate analysis: odds ratio [OR]=3.64, 95% confidence interval [CI] 1.35–9.81, p =0.011) and BIPQ score (OR=1.25, 95% CI 1.17–1.33, p <0.001) were identified as factors associated with good adherence. Conclusion Medical adherence to warfarin needs to improve in rural patients with AF. Efforts that can reduce the number of co-dispensed drugs and increase illness perception may improve warfarin adherence. This study may benefit future management of warfarin administration to rural patients with AF.

Drug-induced thrombocytosis is difficult to identify and is rarely reported. Here, we report a probable rare case of imipenem–cilastatin-induced thrombocytosis in a 51-year-old female. The patient received imipenem–cilastatin treatment because of an intra-abdominal infection, following which the platelet count increased to a peak value of 1058×109 cells/L in 14 days. When imipenem–cilastatin was replaced by levofloxacin and amikacin, the platelet count decreased progressively and remained within the normal range until the 6-month follow-up. Moreover, platelet counts were independent of the infection. Thrombocytosis was probably attributable to imipenem–cilastatin with a Naranjo score of seven. This is a probable rare case in which the thrombocytosis was likely an adverse reaction induced by imipenem–cilastatin. We suggest that clinicians need to be vigilant concerning the impact of imipenem–cilastatin on platelet count in patients with thrombocytosis.