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Insights into direct oral anticoagulant therapy implementation of stroke survivors with atrial fibrillation in an ambulatory setting
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift) |
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ID |
4626500 |
Author(s) |
Albert, Valerie; Polymeris, Alexandros A; Dietrich, Fine; Engelter, Stefan T; Hersberger, Kurt E; Schaedelin, Sabine; Lyrer, Philippe A; Arnet, Isabelle |
Author(s) at UniBasel |
Arnet, Isabelle Albert, Valerie Polymeris, Alexandros Dietrich, Fine Michèle Engelter, Stefan Hersberger, Kurt Schädelin, Sabine Lyrer, Philippe A.
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Year |
2021 |
Title |
Insights into direct oral anticoagulant therapy implementation of stroke survivors with atrial fibrillation in an ambulatory setting |
Journal |
J Stroke Cerebrovas Dis |
Volume |
30 |
Number |
2 |
Pages / Article-Number |
105530 |
Keywords |
Atrial fibrillation; Direct oral anticoagulants; Electronic monitoring; Ischemic stroke; Medication adherence |
Mesh terms |
Aged; Aged, 80 and over; Ambulatory Care; Atrial Fibrillation, complications, diagnosis, drug therapy; Drug Administration Schedule; Factor Xa Inhibitors, administration & dosage, adverse effects; Female; Health Knowledge, Attitudes, Practice; Humans; Ischemic Stroke, diagnosis, etiology; Male; Medication Adherence; Patient Education as Topic; Time Factors; Treatment Outcome |
Abstract |
To describe how stroke survivors with atrial fibrillation implement direct oral anticoagulant treatment and propose appropriate metrics to describe adherence.; Stroke 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.; Data 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.; Although 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. |
ISSN/ISBN |
1532-8511 |
Full Text on edoc |
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Digital Object Identifier DOI |
10.1016/j.jstrokecerebrovasdis.2020.105530 |
PubMed ID |
http://www.ncbi.nlm.nih.gov/pubmed/33333334 |
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03/06/2023
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