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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)
 
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.
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
Digital Object Identifier DOI 10.1016/j.jstrokecerebrovasdis.2020.105530
PubMed ID http://www.ncbi.nlm.nih.gov/pubmed/33333334
   

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