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Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature270279
Source
J Thromb Haemost. 2015 Apr;13(4):495-504
Publication Type
Article
Date
Apr-2015
Author
A. Gorst-Rasmussen
F. Skjøth
T B Larsen
L H Rasmussen
G Y H Lip
D A Lane
Source
J Thromb Haemost. 2015 Apr;13(4):495-504
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Aged, 80 and over
Antithrombins - administration & dosage - adverse effects
Atrial Fibrillation - diagnosis - drug therapy - epidemiology
Cohort Studies
Comorbidity
Dabigatran - administration & dosage - adverse effects
Denmark - epidemiology
Drug Prescriptions
Female
Health Knowledge, Attitudes, Practice
Hemorrhage - chemically induced
Humans
Male
Medication Adherence
Middle Aged
Registries
Risk factors
Stroke - diagnosis - epidemiology - prevention & control
Time Factors
Treatment Outcome
Abstract
There is a perception among physicians that lack of routine monitoring with non-vitamin K antagonist oral anticoagulants (NOACs) may lead to poor adherence to medication. We studied adherence during the first year of usage in a cohort of patients with newly diagnosed non-valvular atrial fibrillation (AF) started on the NOAC, dabigatran etexilate.
Nationwide Danish patient and prescription purchase registries were used to identify newly diagnosed AF patients taking dabigatran, comorbidities, and refill patterns under a twice-daily, one pill regimen. Adherence was characterized among remaining users (N = 2960) after 1 year using the proportion of days covered (PDC), gap rates and restart rates. The overall 1-year PDC was 83.9%, with 76.8% of patients having a 1-year PDC in excess of 80%. Patients with a CHA2 DS2 -VASc score = 2 were more adherent to medication regimes than patients with a CHA2 DS2 -VASc score of 1 (PDC ratio, 1.12; 95% confidence interval [CI], 1.08-1.17) and generally patients with higher morbidity showed more adherence. Patients with prior bleeding were not less adherent to medication regimes than patients with no prior bleeding (PDC ratio, 1.02; 95% CI, 0.98-1.06). The overall gap rate was 1.4 gaps per year. There were no clear tendencies in gap rates among subgroups, although patients with higher morbidity tended to have slightly more, but shorter, gap periods.
More than 75% of patients were showed > 80% adherence to medication regimes during the first year. Patients with higher morbidity, including patients with a higher risk of stroke or bleeding, exhibited better adherence. This improvement may be attributable to more regular contact with the healthcare system.
PubMed ID
25594442 View in PubMed
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