Patient Satisfaction with Direct Oral Anticoagulants and Warfarin

Abstract

The burden of anticoagulation treatment affects patient satisfaction, which in turn affects adherence to treatment. Thus, we must thoroughly understand the advantages of direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs)/warfarin given for stroke prevention in patients with atrial fibrillation (AF). We compared satisfaction with anticoagulation therapy between 654 DOAC and 821 warfarin users enrolled in the SAKURA AF Registry. Satisfaction was assessed by means of the Anti-Clot Treatment Scale (ACTS), which includes 12-item burdens and 3-item benefits scales, and the treatment satisfaction questionnaire for medication II (TSQM II), which includes 2-item effectiveness, 3-item side effects, 3-item convenience, and 2-item global satisfaction domains. There were no significant between-group differences in TSQM II convenience (67.6 14.5 versus 68.9 14.5, P = 0.280), effectiveness (65.0 13.3 versus 66.0 15.0, P = 0.422), side effects (93.6 13.7 versus 92.8 14.4, P = 0.067), and global satisfaction (64.7 14.9 versus 66.0 14.6, P = 0.407) scores. In contrast, although there was no significant between-group difference in the ACTS benefits scores (9.8 3.1 versus 10.1 3.2, P = 0.051), the ACTS burdens scores (54.5 6.3 versus 52.7 6.9, P < 0.0001) were significantly higher in the DOAC users, independent of age, sex, and DOAC type. We can expect greater burden satisfaction with anticoagulation treatment in patients given a DOAC versus VKA/warfarin. The reduced burden of treatment will translate to greater patient adherence to their treatment plans and a positive effect on clinical outcomes.

Clinical Outcomes of Off-Label Dosing of Direct Oral Anticoagulant Therapy Among Japanese Patients With Atrial Fibrillation Identified From the SAKURA AF Registry

“…The study design, data collection processes and baseline characteristics of the study population have been reported. 8,9 Patient eligibility for enrollment into the registry was as follows: a diagnosis of non-valvular AF, based on 12-lead ECG, 24-hour Holter ECG recording or event-activated ECG recording; age ≥20 years; and treatment (either just initiated or already in place) using any anticoagulant drug for stroke prophylaxis. Recruitment began in September 2013 and ended in December 2015.…”

“…These patient characteristics are well known to be strong risks for adverse clinical events, and more specifically, death. [2][3][4][5][6][7]9 The effects of these factors may not have been completely controlled for in our analysis, even after multivariate adjustment. Therefore, the association between off-label DOAC over-dose or appropriate low-dose and a higher incidence rate of the composite net clinical events and death might reflect this inherent patient bias, rather than the specific dose used.…”

Adverse Clinical Events during Long-Term Follow-Up After Catheter Ablation of Atrial Fibrillation

“…Data from patients in the non-ablation group were collected from the SAKURA AF Registry (UMIN Clinical Trials Registry: UMIN000014420). [8][9][10] The study design, data collection method, and patients' clinical characteristics were reported previously. 8) Patients were eligible for inclu-sion in the registry if they had nonvalvular AF diagnosed on a 12-lead electrocardiogram (ECG), 24-hour Holter ECG, or event-activated ECG recording, were aged !20 years, or had started on, or were already being treated with, any anticoagulant drug for stroke prophylaxis.…”

Feasibility of Uninterrupted Direct Oral Anticoagulants with Temporary Switching to Dabigatran ("Dabigatran Bridge") for Catheter Ablation of Atrial Fibrillation

“…[1][2][3] Recently, direct oral anticoagulants (DOACs) offering important advantages beyond their ease of administration, such as less interactions and the nonessentiality of laboratory monitoring, have become available. 4,5) With the advent of DOACs, rapidly increasing numbers of patients with AF are on DOACs at the time the decision to proceed with AF ablation is made. Pro-spective randomized clinical trials have shown that the uninterrupted use of a factor Xa inhibitor is feasible, with no meaningful difference in the thromboembolic events or major bleeding events as compared with uninterrupted warfarin.…”