Association between once- and twice-daily direct oral anticoagulant adherence in nonvalvular atrial fibrillation patients and rates of ischemic stroke

Alberts, Mark J.; Peacock, W. Frank; Fields, Larry E.; Bunz, Thomas J.; Nguyen, Elaine; Milentijevic, Dejan; Schein, Jeff; Coleman, Craig I.

doi:10.1016/j.ijcard.2016.03.212

Cited by 57 publications

(60 citation statements)

References 9 publications

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“…However, selection of patients who are at lower risk for non-adherence, frequent visits during the study, and impact of researchers on patients to take the drug make hard the objective evaluation of medication adherence in relation to dosage frequency. In the real-world study performed by Alberts et al [16], medication persistence was higher in NVAF patients receiving oncedaily dose NOAC combination than those receiving twicedaily dose [16]. In the analysis of healthcare claims from the Humana database, medication adherence of patients receiving rivaroxaban (72.7%) was better compared to patients receiving dabigatran (67.2%) and apixaban (69.5%) [10].…”

Section: Discussionmentioning

confidence: 94%

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

Emren

Kılıç

Berilgen³

et al. 2017

Bosn J of Basic Med Sci

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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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Section: Discussionmentioning

confidence: 94%

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

Emren

Kılıç

Berilgen³

et al. 2017

Bosn J of Basic Med Sci

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“…Recent results, however, have not in general lent much support to the hypothesis that skipping one pill with an OD drug has a greater detrimental effect than for a BID drug [17]. In summary, although the issue of OD vs BID should be seen in its complexity [16] (see also the higher possible risk of overdosing with the accidental overingestion of one or several pills of an OD vs a BID drug), the authors concluded that the advantages of achieving better adherence with an OD drug outweigh the higher theoretical risks deriving from skipping doses or overdosing.…”

Section: Ten Selected Questions and Answersmentioning

confidence: 99%

Edoxaban in Atrial Fibrillation and Venous Thromboembolism—Ten Key Questions and Answers: A Practical Guide

et al. 2017

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Edoxaban is the fourth non-vitamin K antagonist oral anticoagulant now available for clinical use in the prevention of stroke/systemic embolism in atrial fibrillation (AF) and in the treatment of venous thromboembolism (VTE), after the completion of large-scale randomized comparative clinical trials with the vitamin K antagonist warfarin. Edoxaban has some peculiar pharmacological properties and outcome data. Here a group of experts in AF and VTE answers a set of questions on its practical use, trying to define the profile of patients that would be most appropriate for its use.

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“…Whether a DOAC is taken once daily (rivaroxaban and edoxaban) or twice daily (apixaban and dabigatran) may affect adherence. Patients with AF or chronic illness had better adherence to medications that were dosed once daily (Alberts et al., ; Bae et al., ; Coleman, Tangirala, & Evers, ; McHorney et al., ). An increased stroke risk because of nonadherence was observed, regardless of whether dosing was once or twice daily (Alberts et al., ).…”

Section: Introductionmentioning

confidence: 99%

“…Patients with AF or chronic illness had better adherence to medications that were dosed once daily (Alberts et al., ; Bae et al., ; Coleman, Tangirala, & Evers, ; McHorney et al., ). An increased stroke risk because of nonadherence was observed, regardless of whether dosing was once or twice daily (Alberts et al., ). Notably, patients taking twice‐daily DOACs were less adherent, regardless of dosing frequency of concomitant medications (Alberts et al., ).…”

Section: Introductionmentioning

confidence: 99%

“…An increased stroke risk because of nonadherence was observed, regardless of whether dosing was once or twice daily (Alberts et al., ). Notably, patients taking twice‐daily DOACs were less adherent, regardless of dosing frequency of concomitant medications (Alberts et al., ). However, in a recent meta‐analysis, twice‐daily DOAC regimens had lower HRs for stroke, SEE, and ICH (Clemens, Noack, Brueckmann, & Lip, ).…”

Section: Introductionmentioning

confidence: 99%

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Use of direct oral anticoagulants for stroke prevention in elderly patients with nonvalvular atrial fibrillation

Oertel

Fogerty

2017

Journal of the American Association of Nurse Practitioners

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Background and purpose Four direct oral anticoagulants (DOACs) are available for the prevention of stroke in nonvalvular atrial fibrillation (NVAF): dabigatran (a direct thrombin inhibitor); and rivaroxaban, apixaban, and edoxaban (factor Xa inhibitors). This article summarizes the safety and efficacy of DOACs for the prevention of stroke in elderly NVAF patients. Methods PubMed was searched to identify published results of randomized, controlled trials evaluating DOACs for stroke prevention in elderly NVAF patients. Pharmacologic and dose recommendations were obtained from the package inserts. Conclusions DOACs are at least as effective as warfarin for stroke prevention in elderly patients with NVAF. Compared with warfarin, DOACs were associated with reduced risk of intracranial hemorrhage, while some DOACs demonstrated an increase in other bleeding events (e.g., gastrointestinal). The faster onset and offset of action and fewer food and drug interactions of DOACs may be an advantage over warfarin for some patients. Implications for practice DOACs are an alternative to warfarin with overall equivalent safety and efficacy in elderly patients with NVAF, and may be preferable for some. Stroke risk must always be balanced against potential bleeding risk when determining an optimal anticoagulation treatment plan. Patients’ needs and preferences will also impact this decision.

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Association between once- and twice-daily direct oral anticoagulant adherence in nonvalvular atrial fibrillation patients and rates of ischemic stroke

Cited by 57 publications

References 9 publications

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

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

Edoxaban in Atrial Fibrillation and Venous Thromboembolism—Ten Key Questions and Answers: A Practical Guide

Use of direct oral anticoagulants for stroke prevention in elderly patients with nonvalvular atrial fibrillation

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