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Adherence to oral anticoagulant therapy in secondary stroke prevention - impact of the novel oral anticoagulants

Please always quote using this URN: urn:nbn:de:bvb:20-opus-144477
  • Background: Oral anticoagulant therapy (OAT) potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA) have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC) have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention. Methods: All patients treated from October 2011 to September 2012 for ischemic stroke or transientBackground: Oral anticoagulant therapy (OAT) potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA) have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC) have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention. Methods: All patients treated from October 2011 to September 2012 for ischemic stroke or transient ischemic attack with a subsequent indication for OAT, at three academic hospitals were entered into a prospective registry, and baseline data and antithrombotic treatment at discharge were recorded. At the 1-year follow-up, we assessed the adherence to different OAT strategies and patients' adherence to their respective OAT. We noted OAT changes, reasons to change treatment, and factors that influence persistence to the prescribed OAT. Results: In patients discharged on OAT, we achieved a fatality corrected response rate of 73.3% (n=209). A total of 92% of these patients received OAT at the 1-year follow-up. We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran. Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence. Conclusion: One-year adherence to OAT after stroke is strong (>90%) and patients who switch therapy most commonly switch toward another OAT. The 1-year adherence rates to VKA and NOAC in secondary stroke prevention do not differ significantly between both therapeutic strategies.show moreshow less

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Metadaten
Author: Sebastian Luger, Carina Hohmann, Daniela Niemann, Peter Kraft, Ignaz Gunreben, Tobias Neumann-Haefelin, Christoph Kleinschnitz, Helmuth Steinmetz, Christian Foerch, Waltraud Pfeilschifter
URN:urn:nbn:de:bvb:20-opus-144477
Document Type:Journal article
Faculties:Medizinische Fakultät / Neurochirurgische Klinik und Poliklinik
Language:English
Parent Title (English):Patient Preference and Adherence
Year of Completion:2015
Volume:9
Pagenumber:1695–1705
Source:Patient Preference and Adherence 2015, 9, 1695-1705. DOI: 10.2147/PPA.S88994
DOI:https://doi.org/10.2147/PPA.S88994
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Tag:adherence; atrial fibrillation; guidelines; non-VKA oral anticoagulants; prevention; scale; stroke; transient ischemic attack; vitamin K antagonists; warfarin
Release Date:2019/01/28
Licence (German):License LogoCC BY-NC: Creative-Commons-Lizenz: Namensnennung, Nicht kommerziell