Abstract
BackgroundNon-vitamin‑K oral anticoagulants (NOACs) are recommended as the first-choice therapy for stroke prevention in patients with non-valvular atrial fibrillation (AF). However, the lack of monitoring may impact patients’ adherence, and non-adherence to medication is a potential hazard to safe and efficacious use. This is the first report with a ‘comparative patient-oriented perspective’ regarding the use of anticoagulant medication in the NOACs era. Our aim was to compare patients’ self-reported practical problems, adverse events and non-adherence to anticoagulation therapy.MethodsA survey was conducted among patients with AF on either NOACs or vitamin‑K antagonists (VKAs). The outcomes were self-reported non-adherence to anticoagulant medication, and patients’ experiences, adverse events and practical problems correlated with the intake of the drug itself.ResultsA total of 765 patients filled out the questionnaire, of which 389 (50.9%) were on VKAs and 376 (49.1%) on NOACs. Age (70.6 ± 8.8 vs 70.3 ± 9.1 years) and male gender (70.4% vs 64.6%) were similar in the two groups. A significantly higher proportion of VKA users than NOAC users reported having frequent (16.2% vs 3.7%, p > 0.001) or occasional (4.1% vs 1.3%, p > 0.001) practical issues with medication intake. Self-reported non-adherence was significantly higher (24.4% vs 18.1%, p = 0.03) among VKA users. The incidence of self-reported adverse events was similar.ConclusionPatient experiences support the current guideline recommendations for NOACs as the first-choice therapy: NOAC therapy resulted in a higher practical feasibility and better adherence when compared with VKA therapy, with a similar incidence of adverse events in both groups.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-01331-x) contains supplementary material, which is available to authorized users.
Highlights
Atrial fibrillation (AF) is associated with increased mortality and morbidity [1]
We report and compare practical problems, adverse events and non-adherence to anticoagulation therapy from a patient-oriented perspective
The purpose of this study is to evaluate patients’ experiences, practical problems, adverse events and non-adherence to anticoagulation therapy with Non-vitamin-K oral anticoagulants (NOACs) and vitamin-K antagonists (VKAs)
Summary
AF patients with at least one risk factor for stroke (e.g. age >65 years, congestive heart failure, hypertension, diabetes, prior stroke/transient ischaemic attack, vascular disease) were usually treated with a vitamin-K antagonist (VKA) for stroke prevention These anticoagulant medicines require intensive monitoring as their effect can fluctuate. The lack of monitoring may impact patients’ adherence, and non-adherence to medication is a potential hazard to safe and efficacious use This is the first report with a ‘comparative patient-oriented perspective’ regarding the use of anticoagulant medication in the NOACs era. Our aim was to compare patients’ self-reported practical problems, adverse events and non-adherence to anticoagulation therapy. The outcomes were self-reported non-adherence to anticoagulant medication, and patients’ experiences, adverse events and practical problems correlated with the intake of the drug itself.
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