Self-reported adherence to anticoagulation and its determinants using the Morisky medication adherence scale

Castellucci, Lana A; Shaw, Joseph R.; Salm, Katrien van der; Erkens, Petra M. G.; Gal, Grégoire Le; Petrcich, William; Carrier, Marc

doi:10.1016/j.thromres.2015.07.007

Cited by 85 publications

(102 citation statements)

References 26 publications

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“…19,26 Other studies found no difference in medication adherence between single-and double-dose regimens. 21,27 In our study, double-dose regimen was identified as one of the independent risk factors affecting medication adherence negatively, which is consistent with the hypothesis that fixed-dose combination has better compliance than with a multi-pill regimen. As mentioned above, bleeding rate was not increased in patients taking the medication twice a day, even though nonadherence augmented the rate of bleeding.…”

Section: Reasons For Nonadherencesupporting

confidence: 89%

“…Castellucci et al found the general adherence level to NOAC as 56.2%, using the 4-item Morisky Adherence Scale based on self-report in 130 patients with venous thromboembolism. 21 In another study, the medication adherence of 80 patients with strokes receiving dabigatran and rivaroxaban for secondary prophylaxis was 75.8% with the 8-item Morisky Adherence Scale, and the results were found to be correlated with PDC method. Our study involved a much larger population, a great majority of which had been using NOAC for a relatively long time due to NVAF.…”

Section: Adherence To Noacmentioning

confidence: 93%

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Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR

Emren

Şenöz

Bi̇lgi̇n

et al. 2017

Clin Appl Thromb Hemost

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Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 + 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P ¼ .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.

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Section: Reasons For Nonadherencesupporting

confidence: 89%

Section: Adherence To Noacmentioning

confidence: 93%

Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR

Emren

Şenöz

Bi̇lgi̇n

et al. 2017

Clin Appl Thromb Hemost

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“…(iii) Prior stroke, as a dramatic life event, may in itself be an adherence-enhancing factor, as previously suggested [13] . This may explain the lower adherence rates in observational studies in mixed populations [4,[9][10][11][12]16] compared to our study, which included only stroke patients.…”

Section: Discussionmentioning

confidence: 73%

Frequency and Determinants of Adherence to Oral Anticoagulants in Stroke Patients with Atrial Fibrillation in Clinical Practice

Polymeris¹,

Traenka²,

Hert³

et al. 2016

Eur Neurol

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Background: Vitamin K antagonists (VKAs) and non-VKA oral anticoagulants (NOACs) are beneficial in patients with stroke and atrial fibrillation (AF). However, little is known about frequency and determinants of adherence to NOACs/VKAs in clinical practice. Methods: This is a single-center explorative study from the Novel Oral Anticoagulants in Stroke Patients (NOACISP)-LONGTERM registry. We included consecutive AF-stroke patients treated with NOACs/VKAs and followed up for 3-24 months. Adherence was assessed at follow-up using structured interviews and quantified as the proportion of prescribed doses taken (PDT). Outcome measures were (i) full adherence, (ii) ≥95% adherence and (iii) ≥80% adherence (i.e., PDT 100/≥95/≥80%). To explore determinants of full adherence, we compared characteristics of fully and non-fully adherent patients. Results: A total of 218 of 251 (86.9%) patients (48% female, mean age 77.9 ± 9.1 years, 78% NOACs; 22% VKAs) were eligible for analysis with a median follow-up of 12 months: fully adherent were 78.4% patients (NOACs 77.1%, VKAs 83.3%, p = 0.35), ≥95% adherent were 95.4% and ≥80% adherent were 97.2%. Fully adherent patients took more pills daily (median (interquartile range) 7 (5-10) vs. 6 (4-8), p = 0.039), had more often previous antithrombotic treatment (70.8 vs. 53.2%, p = 0.023), caregiver-assisted medication administration (54.2 vs. 19.1%, p < 0.001) and functional dependency (32.8 vs. 15%, p = 0.011) than non-fully adherent patients. Conclusions: Full adherence was frequent. Patients naïve to antithrombotics, taking few pills, which they self-administer, were at the highest risk of non-adherence and may benefit most from adherence-enhancing interventions.

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“…Other studies, also conducted in specialist services, but using the 4-item Morisky Medication Adherence Scale (MMAS-4), 26 found treatment adherence rates of 39% to 50%. 3,7,27 The MMAS-8 is a low-cost method that is easy to administer and offers good sensitivity but low specificity, i.e., a low proportion of individuals within the therapeutic range were defined as adherent to treatment. Of the 22 participants who were within the correct therapeutic range, just two were defined as adherent according to the MMAS-8 (9.1%).…”

Section: Questions Asked About Treatment With Warfarinmentioning

confidence: 99%

Nível de informação e adesão à terapia de anticoagulação oral com varfarina em pacientes acompanhados em ambulatório de atenção primária à saúde

2018

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Background: Oral anticoagulation therapy with warfarin is widely used around the world and its safety and efficacy are well-established. Nevertheless, anticoagulants are among the drug classes most associated with fatal medication errors in primary health care. Objective: To investigate patient knowledge, the level of information provided, and medication adherence in patients treated with warfarin at a primary health care service. Method: A cross-sectional study of a prospective cohort of 60 patients on warfarin treatment in the town of Ijuí, Rio Grande do Sul, Brazil. A questionnaire was administered to test patients' knowledge about their prescriptions and the level of information provided by the health team. The 8-item Morisky Medication Adherence Scale (MMAS-8) and International Normalized Ratio (INR) were used to verify adherence to treatment. Results: The results were expressed in absolute and relative values and prevalence ratios were calculated, with respective 95% confidence intervals. It was found that 83.3% of the participants had been given insufficient information by the health team, 50% did not know how to use the medication correctly, 86.7% were not adherent to the treatment according to MMAS-8 and 63.3% were outside of the correct INR range. Conclusion: In this study, we observed a need to improve the quality of information provided to users and to develop strategies to improve adherence to treatment, to ensure the safety of patients treated with warfarin in primary health care services.

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Self-reported adherence to anticoagulation and its determinants using the Morisky medication adherence scale

Cited by 85 publications

References 26 publications

Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR

Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR

Frequency and Determinants of Adherence to Oral Anticoagulants in Stroke Patients with Atrial Fibrillation in Clinical Practice

Nível de informação e adesão à terapia de anticoagulação oral com varfarina em pacientes acompanhados em ambulatório de atenção primária à saúde

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