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Direct oral anticoagulants: patient reported adherence and minor bleedings
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Internal Medicine Clinic, Sundsvall hospital, Sundsvall, Sweden.ORCID iD: 0000-0003-0845-1634
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Internal Medicine Clinic, Sundsvall hospital, Sundsvall, Sweden.ORCID iD: 0000-0001-9422-1186
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Internal Medicine Clinic, Sundsvall hospital, Sundsvall, Sweden.
2023 (English)In: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 56, no 1, p. 55-64Article in journal (Refereed) Published
Abstract [en]

Data regarding adherence and minor bleeding on direct oral anticoagulants in everyday life are still sparse. Inclusion criteria: treatment initiated with dabigatran, rivaroxaban or apixaban in non-valvular atrial fibrillation patients from a center in northern Sweden between 2011 and 2019 (n = 668). Exclusion criteria: cognitive impairment, dose dispensing, need of interpreter or hospital admission (n = 67). By a telephone interview adherence was measured in 569 patients (response rate 94.8%) using the 8-item Morisky medication adherence scale and minor bleeding was asked for. CHA2DS2-VASc and HAS-BLED scores were collected from medical records. The number (n), mean age, mean treatment duration, mean (points) CHA2DS2-VASc and HAS-BLED scores was with dabigatran (n = 175, 73.3 years, 17.8 months, 3.6 p and 2.2 p), rivaroxaban (n = 198, 73.7 years, 21months, 3.8 p and 2.1 p) and apixaban (n = 196, 72.7 years, 15.2 months, 3.4 p and 2.1 p). Adherence was high for dabigatran, rivaroxaban and apixaban in 54%, 76% and 53%; intermediate in 37%, 20% and 37% or low in 9%, 4% and 10% respectively. High adherence (Morisky score 8) distinguished rivaroxaban (p < 0.0001) and in patients with CHA2DS2-VASc ≥ 4 p, (p < 0.0001). Patients on rivaroxaban/apixaban reported more minor bleedings (37% / 28%) compared to dabigatran (13%), (p < 0.001). Only 61% of the patients followed prescription. Adherence to rivaroxaban was significantly better, maybe due to the once daily dosing regimen, and furthermore among patients with higher risk for stroke. Minor bleedings were less common in the dabigatran group. The impact of minor bleedings on adherence and a possible relationship to clinical outcomes need to be further studied.

Place, publisher, year, edition, pages
Springer, 2023. Vol. 56, no 1, p. 55-64
Keywords [en]
8-item Morisky medication adherence scale, Adherence, Atrial fibrillation, Direct oral anticoagulants, Minor bleedings, Real world
National Category
Cardiology and Cardiovascular Disease
Identifiers
URN: urn:nbn:se:umu:diva-208225DOI: 10.1007/s11239-023-02797-8ISI: 000976121900001PubMedID: 37119356Scopus ID: 2-s2.0-85153928648OAI: oai:DiVA.org:umu-208225DiVA, id: diva2:1756506
Funder
Umeå UniversityAvailable from: 2023-05-12 Created: 2023-05-12 Last updated: 2025-02-10Bibliographically approved

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Själander, AndersWallvik, Jonas

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