Type and doses of oral anticoagulants and adherence to anticoagulant treatment in elderly patients with atrial fibrillation: the ESPARTA study

Mostaza, José María; Fernández, Carmen Suárez; Guerra, Luis Castilla; Suriñach, Josep Maria; Tamarit, Juan José; Palencia, José Luis Díaz; Polo, Iluminada García; Santamaria, Esther Francia; Fernández, María; Acebal, Carla de la Guerra; Ramos, M.T. Pastor; Ràfols, Carles

doi:10.2217/cer-2017-0034

Cited by 17 publications

(9 citation statements)

References 21 publications

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“…Este estudio es el primero en Colombia que ha logrado evaluar cuáles factores se encuentran relacionados con la independiente de este riesgo 19 , ya que un paciente requiere por lo menos 295 caídas para perder el beneficio de la anticoagulación 20 . En nuestro estudio, las caídas no afectaron la adherencia al tratamiento al igual que lo describió el estudio ESPARTA realizado en España 21 .…”

Section: Discussionunclassified

Adherencia al tratamiento anticoagulante oral por fibrilación auricular no valvular en personas mayores de 65 años

Rodríguez-Rocha¹,

Chacón-Valenzuela²,

Cadena-Sanabria³

et al. 2022

RCCAR

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Introducción: la fibrilación auricular no valvular es la arritmia cardiaca más frecuente en las personas mayores que se ha relacionado con diferentes desenlaces adversos, como el ataque cerebrovascular, el cual en el 80% de los casos se puede prevenir con anticoagulantes orales, beneficio que está condicionado por una adecuada adherencia terapéutica. Objetivo: determinar la adherencia al tratamiento anticoagulante en pacientes mayores de 65 años con fibrilación auricular no valvular y factores asociados. Método: estudio observacional analítico de corte transversal, realizado

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Section: Discussionunclassified

Adherencia al tratamiento anticoagulante oral por fibrilación auricular no valvular en personas mayores de 65 años

Rodríguez-Rocha¹,

Chacón-Valenzuela²,

Cadena-Sanabria³

et al. 2022

RCCAR

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“…Accordingly, real-world studies evaluating DOACs in the Spanish population are scarce. A few retrospective studies have been published based on databases containing electronic health records [17,18,19,20,21] or prospective registries [11], but most of these studies have focused exclusively on the distribution of the different DOACs/doses prescribed and patients characteristics [17,18,19,20,21] and only a few have analyzed stroke and bleeding events [11,12,13,22]. To our knowledge, the study by Cerda et al [13], performed in a cohort of 1443 patients from a single center is the only one with a comparable methodology to ours, showing similar basal characteristics and follow-up of our cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation: A Real-World Experience from a Single Spanish Regional Hospital

Rodilla¹,

Orts-Martinez²,

Sanz-Caballer³

et al. 2021

Preprint

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The aim is to evaluate a program for direct oral anticoagulants (DOACs) management in nonvalvular atrial fibrillation (NVAF) patients, according to patient profiles, appropriateness of dosing, patterns of crossover, effectiveness and safety. This is an observational and longitudinal retrospective study in a cohort of patients attended in daily clinical practice in a single regional hospital in Spain with a systematic follow-up plan for up to 3 years for patients initiating dabigatran, rivaroxaban or apixaban between JAN/2012-DEC/2016. We analyzed 490 episodes of treatment (apixaban 2.5 mg: 9.4%, apixaban 5 mg: 21.4%, dabigatran 75 mg: 0.6%, dabigatran 110 mg: 12,4%, dabigatran 150 mg: 19.8%, rivaroxaban 15 mg: 17.8% and rivaroxaban 20 mg: 18.6%) in 445 patients. 13.6% of patients on dabigatran, 9.7% on rivaroxaban, and 3.9% on apixaban, switched to other DOACs or changed dosing. Apixaban was the most frequent DOAC switched to. The most frequent reasons for switching were toxicity (23.8%), bleeding (21.4%) and renal deterioration (16.7%). Inappropriateness of dose was found in 23.8% of episodes. Patients taking apixaban 2.5 mg were older, had higher CHA2DS2VASc score and lower creatinine clearance. Patients taking dabigatran 150 mg and rivaroxaban 20 mg were younger, had lower CHA2DS2VASc and higher creatinine clearance. Rates of stroke/transient ischemic attack (TIA) were 1.64/0.54 events/100 patients-years, while rates of major, clinically relevant non-major (CRNM) bleeding and intracranial bleeding where 2.4, 5, and 0.5 events/100 patients-years. Gastrointestinal and genitourinary bleeding were the most common type of bleeding events (BE). On multivariable analysis, prior stroke (RR: 4.2; CI: 1.5-11.8; p=0.006) and age (RR: 1.2; CI: 1.1-1.4; p=0.006) were independent predictors of stroke/TIA. Concurrent platelet inhibitors (RR: 7.1; CI: 2.3-21.8; p=0.001), male gender (RR: 2.1; CI: 1.2-3.7; p=0.0012) and age (RR: 1.1; CI: 1.02-1.13; p=0.005) were independent predictors of BE. This study complements the scant data available on the use of DOACs in NVAF patients in Spain, confirming a good safety and effectiveness profile

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“…Many studies considered adherence to both VKAs and DOACs together. An analysis of 837 AF adults ≥ 75 years on OACs ≥ 3 months observed poor adherence in 27.9% of patients [ 183 ]. In a cross-sectional, single-center observational survey study, adequate treatment adherence was found in three-quarters of patients [ 184 ].…”

Section: Adherence To Oral Anticoagulant Intakementioning

confidence: 99%

“…Multivariable analyses revealed that age ≤ 60 years is a predictor of non-adherence and non-persistence [ 190 ], whereas advanced age is associated with higher adherence rates [ 181 , 186 , 187 , 191 , 200 ]. However, higher scores in fragility scales in the elderly are associated with poorer adherence [ 183 ], and in 785 consecutive outpatients, those over 75 years were more likely to forget the assumption of OAC [ 201 ].…”

Section: Agementioning

confidence: 99%

Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

Lucà,

Oliva,

Abrignani

et al. 2023

JCM

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It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug–drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.

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Type and doses of oral anticoagulants and adherence to anticoagulant treatment in elderly patients with atrial fibrillation: the ESPARTA study

Abstract: 28% of patients had a poor adherence to anticoagulant treatment. 62% of patients were treated with the lower doses of DOACs.

Cited by 17 publications

References 21 publications

Adherencia al tratamiento anticoagulante oral por fibrilación auricular no valvular en personas mayores de 65 años

Adherencia al tratamiento anticoagulante oral por fibrilación auricular no valvular en personas mayores de 65 años

Direct Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation: A Real-World Experience from a Single Spanish Regional Hospital

Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

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