Valerie Albert1, Alexandros A Polymeris2, Fine Dietrich3, Stefan T Engelter4, Kurt E Hersberger5, Sabine Schaedelin6, Philippe A Lyrer7, Isabelle Arnet8. 1. Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, Postfach 2148, 4051 Basel, Switzerland, Tel: +41 61 207 14 26. Electronic address: valerie.albert@unibas.ch. 2. Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland, Tel: +41 61 265 44 91. Electronic address: alexandros.polymeris@usb.ch. 3. Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, Postfach 2148, 4051 Basel, Switzerland, Tel: +41 61 207 14 26. Electronic address: fine.dietrich@unibas.ch. 4. Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland, Tel: +41 61 265 44 91; Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland, Tel: +41 61 326 41 05. Electronic address: Stefan.Engelter@usb.ch. 5. Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, Postfach 2148, 4051 Basel, Switzerland, Tel: +41 61 207 14 26. Electronic address: kurt.hersberger@unibas.ch. 6. Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland, Tel: +41 61 556 51 67. Electronic address: sabine.schaedelin@usb.ch. 7. Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland, Tel: +41 61 265 44 91. Electronic address: Philippe.Lyrer@usb.ch. 8. Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, Postfach 2148, 4051 Basel, Switzerland, Tel: +41 61 207 14 26. Electronic address: isabelle.arnet@unibas.ch.
Abstract
OBJECTIVES: To describe how stroke survivors with atrial fibrillation implement direct oral anticoagulant treatment and propose appropriate metrics to describe adherence. MATERIALS AND METHODS: Stroke patients with atrial fibrillation electronically recorded their self-administered direct oral anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban) during a 6-month observation phase after hospitalisation for ischemic stroke. Taking and timing adherence, correct dosing days, drug holidays, time of the day and day of the week subsets, dose-to-dose intervals and longest intervals between two consecutive doses were calculated from electronic monitoring data to describe and discuss the implementation phase of adherence. RESULTS: Data from 41 patients were analysed. Median age was 77 (IQR = 69-84), 63.4% were male and the majority suffered a mild stroke (median NIHSS: 1). Mean taking and timing adherence exceeded 90%. Correct dosing occurred in 86.6% of the days. Seven patients (17.1%) had intake pauses of three or more consecutive days. Patients with twice-daily regimen (70.7%) had higher taking adherence in the morning than in the evening (94.4% versus 89.9%; p = 0.001). No therapy- or anamneses-related characteristic was associated with taking adherence. CONCLUSIONS: Although adherence to direct oral anticoagulants of stroke patients with atrial fibrillation exceeded 90%, deviant intake patterns such as drug holidays and missed evening doses were common and raise concerns. Appropriate adherence metrics calculated from electronic monitoring data may guide healthcare professionals elucidating patient-tailored adherence-enhancing interventions. ClinicalTrials.gov registration number: NCT03344146.
OBJECTIVES: To describe how stroke survivors with atrial fibrillation implement direct oral anticoagulant treatment and propose appropriate metrics to describe adherence. MATERIALS AND METHODS:Strokepatients with atrial fibrillation electronically recorded their self-administered direct oral anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban) during a 6-month observation phase after hospitalisation for ischemic stroke. Taking and timing adherence, correct dosing days, drug holidays, time of the day and day of the week subsets, dose-to-dose intervals and longest intervals between two consecutive doses were calculated from electronic monitoring data to describe and discuss the implementation phase of adherence. RESULTS: Data from 41 patients were analysed. Median age was 77 (IQR = 69-84), 63.4% were male and the majority suffered a mild stroke (median NIHSS: 1). Mean taking and timing adherence exceeded 90%. Correct dosing occurred in 86.6% of the days. Seven patients (17.1%) had intake pauses of three or more consecutive days. Patients with twice-daily regimen (70.7%) had higher taking adherence in the morning than in the evening (94.4% versus 89.9%; p = 0.001). No therapy- or anamneses-related characteristic was associated with taking adherence. CONCLUSIONS: Although adherence to direct oral anticoagulants of strokepatients with atrial fibrillation exceeded 90%, deviant intake patterns such as drug holidays and missed evening doses were common and raise concerns. Appropriate adherence metrics calculated from electronic monitoring data may guide healthcare professionals elucidating patient-tailored adherence-enhancing interventions. ClinicalTrials.gov registration number: NCT03344146.
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: Fine Dietrich; Alexandros A Polymeris; Isabelle Arnet; Philippe A Lyrer; Melina Verbeek; Stefan T Engelter; Kurt E Hersberger; Sabine Schaedelin Journal: J Neurol Date: 2021-06-03 Impact factor: 4.849
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