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.
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 StrokePatients (NOACISP)-LONGTERM registry. We included consecutive AF-strokepatients 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.
Authors: Alexandros A Polymeris; Annaelle Zietz; Fabian Schaub; Louisa Meya; Christopher Traenka; Sebastian Thilemann; Benjamin Wagner; Lisa Hert; Valerian L Altersberger; David J Seiffge; Flurina Lyrer; Tolga Dittrich; Ines Piot; Josefin Kaufmann; Lea Barone; Ludvig Dahlheim; Sophie Flammer; Nikolaos S Avramiotis; Nils Peters; Gian Marco De Marchis; Leo H Bonati; Henrik Gensicke; Stefan T Engelter; Philippe A Lyrer Journal: Eur Stroke J Date: 2022-05-10
Authors: Daniela Rohde; Niamh A Merriman; Frank Doyle; Kathleen Bennett; David Williams; Anne Hickey Journal: PLoS One Date: 2017-12-08 Impact factor: 3.240
Authors: David J Seiffge; Gian Marco De Marchis; Masatoshi Koga; Maurizio Paciaroni; Duncan Wilson; Manuel Cappellari; Kosmas Macha Md; Georgios Tsivgoulis; Gareth Ambler; Shoji Arihiro; Leo H Bonati; Bruno Bonetti; Bernd Kallmünzer; Keith W Muir; Paolo Bovi; Henrik Gensicke; Manabu Inoue; Stefan Schwab; Shadi Yaghi; Martin M Brown; Philippe Lyrer; Masahito Takagi; Monica Acciarrese; Hans Rolf Jager; Alexandros A Polymeris; Kazunori Toyoda; Michele Venti; Christopher Traenka; Hiroshi Yamagami; Andrea Alberti; Sohei Yoshimura; Valeria Caso; Stefan T Engelter; David J Werring Journal: Ann Neurol Date: 2020-02-12 Impact factor: 10.422
Authors: Alexandros A Polymeris; Thomas R Meinel; Jan C Purrucker; David J Seiffge; Hannah Oehler; Kyra Hölscher; Annaelle Zietz; Jan F Scheitz; Christian H Nolte; Christoph Stretz; Shadi Yaghi; Svenja Stoll; Ruihao Wang; Karl Georg Häusler; Simon Hellwig; Markus G Klammer; Simon Litmeier; Christopher R Leon Guerrero; Iman Moeini-Naghani; Patrik Michel; Davide Strambo; Alexander Salerno; Giovanni Bianco; Carlo Cereda; Timo Uphaus; Klaus Gröschel; Mira Katan; Susanne Wegener; Nils Peters; Stefan T Engelter; Philippe A Lyrer; Leo H Bonati; Lorenz Grunder; Peter Arthur Ringleb; Urs Fischer; Bernd Kallmünzer Journal: J Neurol Neurosurg Psychiatry Date: 2022-04-08 Impact factor: 13.654
Authors: Lisa Hert; Alexandros A Polymeris; Sabine Schaedelin; Johanna Lieb; David J Seiffge; Christopher Traenka; Joachim Fladt; Sebastian Thilemann; Henrik Gensicke; Gian Marco De Marchis; Leo Bonati; Philippe Lyrer; Stefan T Engelter; Nils Peters Journal: Eur Stroke J Date: 2019-11-12