Association between Cerebral Infarction Risk and Medication Adherence in Atrial Fibrillation Patients Taking Direct Oral Anticoagulants

Abstract

Direct oral anticoagulants (DOACs) are available for nonvalvular atrial fibrillation patients. The advantage of DOACs is that regular anticoagulation monitoring is not required. However, adherence to the recommended regimen is essential. We investigated the association between medication adherence and the risk of cerebral infarction in patients taking DOACs. Patients admitted to any of the participating hospitals for cerebral infarction from September 2018 to February 2020 and prescribed DOACs before admission were defined as the case group, and patients hospitalized for diseases other than cerebral infarction, except for bleeding disorders, and prescribed DOACs before admission were defined as the control group. A nested case–control study was adapted, and 58 and 232 patients were included in the case and control groups, respectively. Medication adherence was assessed by the pharmacists through standardized interviewing. The adjusted odds ratio for the risk of cerebral infarction for low-adherence patients (<80% adherence rate) against good-adherence patients (100% adherence rate) was 9.69 (95% confidence interval, 3.86–24.3; p < 0.001). The patients’ age and other background characteristics were not found to be risk factors for cerebral infarction. In conclusion, low adherence is a risk factor for cerebral infarction in patients taking DOACs. Pharmacists should focus on maintaining ≥80% adherence to DOAC therapy to prevent cerebral infarction.

Optimization of DOAC management services in a centralized anticoagulation clinic

“… 5 Real‐world data also demonstrate that poor adherence to DOACs results in decreased efficacy and increased risk of adverse events. 6 , 7 These observations support the need for centralized management of patients on DOACs. An Anticoagulation Management Service (AMS) providing DOAC services can optimize anticoagulation therapy during transitions of care, where many opportunities for medication errors arise.…”

“…Inappropriate prescribing was associated with an increased risk of thromboembolic and hemorrhagic events 5 . Real‐world data also demonstrate that poor adherence to DOACs results in decreased efficacy and increased risk of adverse events 6,7 . These observations support the need for centralized management of patients on DOACs.…”

Adherence, persistence and switching rates of apixaban, dabigatran and rivaroxaban in non-valvular atrial fibrillation: a multicentre real-life analysis at 3 years

“…In light of the above data, it is essential to monitor and follow up patients with NVAF in their course of care, and this is supported by studies in the literature which show that the management of patients treated with DOACs under the supervision of pharmacists is associated with greater adherence to treatment in real life 52…”

Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

“…It has been shown that there is a 25% likelihood that patients on DOACs will undergo a surgical or interventional procedure over a period of 24 months [ 102 ].…”

“…According to the most recent guidelines [ 102 ], if there is a need for surgery during the DOAC strategy, several factors, such as the kind of surgery and its specific bleeding risk, the patient’s characteristics, and the anticoagulation type, should be evaluated. Moreover, whether the procedure is urgent or not is crucial for patient management.…”