Abstract
ObjectivesTo describe how stroke survivors with atrial fibrillation implement direct oral anticoagulant treatment and propose appropriate metrics to describe adherence. Materials and MethodsStroke 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. ResultsData 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. ConclusionsAlthough 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
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of ischemic stroke by about five times.[1]
Median National Institute of Health Stroke Scale (NIHSS) was 1.0 (IQR = 0.0À2.5) and functional outcome was favourable for 78.0% of the patients
In accordance with Vrijens et al.[8] who state that a simple percentage does not describe the behaviour of medication intake, our study shows that summary metrics such as taking and timing adherence do not provide a sufficient description of medication intake behaviour
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of ischemic stroke by about five times.[1] Oral anticoagulation (OAC) with direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) reduces ischemic stroke risk in AF patients. DOAC (apixaban, dabigatran, edoxaban and rivaroxaban) are recommended as first-line treatment for stroke prevention in AF patients.[2] Despite several advantages compared to VKA, DOAC have a short half-life of about 12 h. Missing more than 5% of intakes is associated with a higher occurrence of thromboembolic events in OAC-treated AF patients.[3] correct implementation of treatment is crucial for stroke prevention with DOAC.[4] Non-adherence to DOAC may be harmful and should be recognised by healthcare professionals
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