<p>Comparing quality of life and treatment satisfaction between patients on warfarin and direct oral anticoagulants: a cross-sectional study</p>

Abstract

Introduction and aim Patient quality of life (QOL) while on long-term oral anticoagulant therapy has been receiving greater attention in recent years due to the increase in life expectancy brought about by advances in medical care. This study aimed to compare the QOL, treatment satisfaction, hospitalization and bleeding rate in patients on long-term warfarin versus direct oral anticoagulants (DOAC). Methods This was a cross-sectional study of patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) on long-term anticoagulant therapy attending the cardiology clinic and anticoagulation clinic of the University Malaya Medical Centre from July 1, 2016, to June 30, 2018. Patient QOL was assessed by using the Short Form 12 Health Survey (SF12), while treatment satisfaction was assessed by using the Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2). Results A total of 208 patients were recruited; 52.4% received warfarin and 47.6% received DOAC. There was no significant difference in QOL between warfarin and DOAC based on SF12 (physical QOL, P =0.083; mental QOL, P =0.665). Nevertheless, patients in the DOAC group were significantly more satisfied with their treatment compared to the warfarin group based on PACT-Q2 ( P =0.004). The hospitalisation rate was significantly higher in the warfarin group than the DOAC group (15.6% versus 3.0%, P =0.002). Clinically relevant minor bleeds and severe bleeding events were non-significantly higher in the warfarin group than the DOAC group (66.7% versus 40.0%, P =0.069). Conclusion Compared to warfarin, treatment of NVAF and VTE with DOAC showed comparable QOL, higher treatment satisfaction, lesser hospitalization, and a non-significant trend toward fewer bleeding episodes.

Time in Therapeutic Range, Quality of Life and Treatment Satisfaction of Patients on Long-Term Warfarin for Non-Valvular Atrial Fibrillation: A Cross-Sectional Study

“…On the other hand, Balci et al reported signi cant improvement in every domain of SF-12v2 (all p < 0.001), (38) while de Caterina et al reported signi cant improvement in severe mobility problem (p = 0.003), pain/discomfort (p = 0.035), and anxiety/depression (p < 0.001) of EuroQoL Instrument 5 levels (EQ-5D-5L) among NVAF patients after switching from warfarin to DOAC. (39) The patients in the current study had slightly higher value in each domain of the SF-12v2 except SF, but much lower mean TTR (47.0% versus 54.9%) and proportion with good TTR (24.3% versus 45.0%) when compared to similar subgroup of patients reported in Ng et al (34) Both studies were conducted in the anticoagulant clinic of a tertiary hospital, but the latter located in the Peninsular of Malaysia. The better social functioning among patients with good TTR in the current study could be due to their higher education level.…”

“…Most of the existing studies either compare the HRQoL of these patients versus those on DOAC, or in a longitudinal manner. Ng et al, (34) Benzimra et al, (35) Contreras et al, (36) and Alegret et al, (37) have reported no signi cant difference in the HRQoL of patients with NVAF receiving long-term warfarin versus DOAC in real-world scenario. On the other hand, Balci et al reported signi cant improvement in every domain of SF-12v2 (all p < 0.001), (38) while de Caterina et al reported signi cant improvement in severe mobility problem (p = 0.003), pain/discomfort (p = 0.035), and anxiety/depression (p < 0.001) of EuroQoL Instrument 5 levels (EQ-5D-5L) among NVAF patients after switching from warfarin to DOAC.…”

Time in Therapeutic Range, Quality of Life and Treatment Satisfaction of Patients on Long-Term Warfarin for Non-Valvular Atrial Fibrillation: A Cross-Sectional Study

“…On the other hand, Balci et al reported signi cant improvement in every domain of SF-12v2 (all p < 0.001),(34) while de Caterina et al reported signi cant improvement in severe mobility problem (p = 0.003), pain/discomfort (p = 0.035), and anxiety/depression (p < 0.001) of EuroQoL Instrument 5 levels (EQ-5D-5L) among NVAF patients after switching from warfarin to DOAC. (35) The patients in the current study had slightly higher value in each domain of the SF-12v2 except SF, but much lower mean TTR (47.0% versus 54.9%) and proportion with good TTR (24.3% versus 45.0%) when compared to similar subgroup of patients reported in Ng et al (30) Both studies were conducted in the anticoagulant clinic of a tertiary hospital, but the latter located in the Peninsular of Malaysia. The better social functioning among patients with good TTR in the current study could be due to their higher education level.…”

“…Most of the existing studies either compare the HRQoL of these patients versus those on DOAC, or in a longitudinal manner. Ng et al, (30) Benzimra et al, (31) Contreras et al, (32) and Alegret et al, (33) have reported no signi cant difference in the HRQoL of patients with NVAF receiving long-term warfarin versus DOAC in real-world scenario. On the other hand, Balci et al reported signi cant improvement in every domain of SF-12v2 (all p < 0.001),(34) while de Caterina et al reported signi cant improvement in severe mobility problem (p = 0.003), pain/discomfort (p = 0.035), and anxiety/depression (p < 0.001) of EuroQoL Instrument 5 levels (EQ-5D-5L) among NVAF patients after switching from warfarin to DOAC.…”

New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study

“…Oztürk et al reported that 33.3% of the patients had experienced minor and/or major bleeding at least once during 1year period, moreover bleeding complications detected in 38.9% of patients ≥ 65 years of age and in 26.2% of patients <65 years of age 25 . A recent study showed that the clinically relevant minor bleeds and severe bleeding events were found 66.7% in the warfarin treatment group during the two-year follow-up 26 . In the present study, minor bleeding rate was found 21.1%.…”