Exploration of adherence and patient experiences with DOACs one year after switching from vitamin-K antagonists- insights from the switching study

Bartoli-Abdou, John K.; Patel, Jignesh P.; Crawshaw, Jacob; Vadher, Bipin; Brown, Alison; Roberts, Lara N.; Patel, Raj; Arya, Roopen; Auyeung, Vivian

doi:10.1016/j.thromres.2017.12.021

Cited by 20 publications

(26 citation statements)

References 47 publications

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“…Second, our study specifically focused on patients who switched from a VKA to a DOAC, whereas in other observational studies only oral anticoagulant (OAC)‐naïve patients or a combination of OAC‐naïve and OAC‐experienced patients were included. We also found a high anticoagulant adherence rate among VKA‐experienced patients in the SFK database, which was also described in other studies . This might be caused by a higher awareness of the importance of therapy adherence in patients with a history of anticoagulant monitoring.…”

Section: Discussionsupporting

confidence: 87%

Self‐reported therapy adherence and predictors for nonadherence in patients who switched from vitamin K antagonists to direct oral anticoagulants

Toorop

Rein

Nierman³

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Many patients who used vitamin K antagonists (VKAs) for long‐term prevention of thromboembolism are now actively switched to a direct oral anticoagulant (DOAC). Strict adherence to a DOAC is crucial for its success. However, therapy adherence and clinical factors that predict nonadherence are currently not well studied among patients who switched from a VKA to a DOAC. Methods A questionnaire was developed and sent to 2920 former patients of 3 anticoagulation clinics in the Netherlands, who switched from a VKA to a DOAC between January 2016 and December 2017. Questions concerned demographics, treatment persistence, adherence, and the occurrence of bleeding or thromboembolic events on DOACs. To identify predictors for nonadherence, logistic regression models were used to estimate crude and age/sex‐adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Results A total of 1399 questionnaires (response rate 48%) were used for analysis. DOAC treatment persistence (94%) and adherence (86%) rates were high. Several predictors of nonadherence were identified, including young age (OR, 5.9; 95% CI, 3.6‐9.8 for <60 years compared to >75 years), low consultation frequency with a specialist (OR, 1.6; 95% CI, 1.1‐2.2), a history of minor bleeding on DOACs (OR, 1.9; 95% CI, 1.3‐2.8), and a twice‐daily dosing regimen (OR, 1.9; 95% CI, 1.3‐2.6). Conclusions Self‐reported treatment persistence and adherence were high in our study population, and several predictors of nonadherence were identified. Factors that can be influenced (low consult frequency with medical specialist, daily dosing regimen) may be used to improve therapy adherence.

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Section: Discussionsupporting

confidence: 87%

Self‐reported therapy adherence and predictors for nonadherence in patients who switched from vitamin K antagonists to direct oral anticoagulants

Toorop

Rein

Nierman³

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…Therefore, the increasing use of DOAC therapy might be expected to continue. It is unclear whether adherence to OAC may be improved by use of DOACs with conflicting evidence . There is still a concern that less frequent interaction with healthcare professionals, in a setting such as a warfarin clinic, may have unintended health consequences for a largely elderly population on OAC.…”

Section: Discussionmentioning

confidence: 99%

“…It is unclear whether adherence to OAC may be improved by use of DOACs with conflicting evidence. 31,39 There is still a concern that less F I G U R E 1 Anticoagulant prescribing trends 2010-2017 for general medical scheme eligible patients frequent interaction with healthcare professionals, in a setting such as a warfarin clinic, may have unintended health consequences for a largely elderly population on OAC. For example, monitoring of renal function is recommended by guidelines, 16 but this may not occur in the hectic setting of primary care.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, patients have expressed a desire to access specialist anticoagulation services following a switch to DOAC therapy which may reflect their concern regarding bleeding events and a wish for closer monitoring while on OAC. 31 The inconvenience and cost of frequent INR monitoring is greater for those distant to a warfarin clinic. 40 It may be reasonable to expect that the absence of a local service to manage warfarin therapy would lead to the more significant adoption of DOAC therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The HSE‐PCRS pharmacy claims database used for this study contains reimbursement records of medicines dispensed by pharmacies to patients in primary care. Medicines were identified by their 7‐digit World Health Organisation anatomical therapeutic chemical classification code …”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Direct oral anticoagulants uptake and an oral anticoagulation paradox

Kennedy

Choitir

Clarke

et al. 2020

Brit J Clinical Pharma

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Oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation is underutilised. One of the impediments to warfarin therapy is the frequent monitoring required, usually at a specialised warfarin clinic. The advent of direct oral anticoagulants (DOACs) facilitates OAC therapy without an onerous monitoring regimen. This benefit may result in the more significant adoption of DOACs in areas without a warfarin clinic. This study analysed national administrative data for reimbursed pharmacy claims to assess OAC prescribing from 2010 to 2017 and compared the use of DOACs in areas with warfarin clinics compared to those without. Over the study period, the number of patients on OAC increased by 84%, due to a rapid increase in DOAC prescribing. The findings demonstrate that DOACs have resulted in an increase in the overall uptake of OAC therapy in Ireland. However, the increased utilisation was not evidently related to populations underserved by warfarin clinics.

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Associations between illness beliefs, medication beliefs, anticoagulation‐related quality of life, and INR control: Insights from the Switching Study

Bartoli-Abdou

Patel

Xie

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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BackgroundAnticoagulation control with vitamin‐K antagonists (VKAs) in patients with atrial fibrillation (AF) or venous thromboembolism (VTE) can be measured using time in therapeutic range (TTR), where TTR >65% is considered good and low TTR may be associated with low adherence.MethodsThis cross‐sectional observational study compared illness beliefs, treatment beliefs, and treatment satisfaction of patients with TTR >75% and TTR <50% using validated tools to determine their association with TTR. Adults requiring chronic VKA therapy were recruited from 2 hospital anticoagulation clinics in London, UK.Results311 patients with TTR >75% and 214 with TTR <50% were recruited. TTR >75% patients had been taking warfarin on average over 2 years longer than TTR <50% patients (P < .001). Statistically significant differences in beliefs were found in all subscales other than in treatment control, general harm, and general overuse. Cluster analysis determined there were 4 distinct clusters of beliefs among patients. Multivariate binary logistic regression found VTE patients were least likely to have poor TTR (OR = 0.49; 95% CI 0.29, 0.77). Patients in the “cautious of therapy and fearful of illness” cluster were most likely to have low TTR (OR = 4.75; 95% CI 2.75, 8.77).ConclusionIllness perceptions, medication beliefs and treatment satisfaction were associated with INR control. VTE patients and those who were accepting of both illness and treatment were most likely to have optimal INR control.

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Exploration of adherence and patient experiences with DOACs one year after switching from vitamin-K antagonists- insights from the switching study

Cited by 20 publications

References 47 publications

Self‐reported therapy adherence and predictors for nonadherence in patients who switched from vitamin K antagonists to direct oral anticoagulants

Self‐reported therapy adherence and predictors for nonadherence in patients who switched from vitamin K antagonists to direct oral anticoagulants

Direct oral anticoagulants uptake and an oral anticoagulation paradox

Associations between illness beliefs, medication beliefs, anticoagulation‐related quality of life, and INR control: Insights from the Switching Study

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