Choi Jiyoon C, Dibonaventura Marco D, Kopenhafer Lewis, Nelson Winnie W
LifeScan, Inc, West Chester, PA.
Health Sciences Practice, Kantar Health, New York, NY.
Patient Prefer Adherence. 2014 Feb 7;8:167-77. doi: 10.2147/PPA.S56187. eCollection 2014.
Oral dabigatran was recently approved as an alternative to warfarin for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Unlike warfarin, dabigatran has a fixed dosage and few drug interactions, and does not require anticoagulation monitoring or dietary restrictions.
This study aimed to describe and compare characteristics of patients with atrial fibrillation who used dabigatran or only warfarin. Patients with a self-reported diagnosis of atrial fibrillation aged ≥18 years who were receiving (or had received) warfarin or dabigatran completed an online survey. Differences in characteristics of dabigatran and warfarin users were tested using chi-squared tests and analysis of variance for categorical and continuous variables, respectively.
Overall, 364 patients were surveyed (204 warfarin users, 160 dabigatran users). The mean age was 65.1 years, and 68.7% were male. Dabigatran users were more likely than warfarin users to be female (36.9% versus 27.0%) and to have experienced adverse events, including gastrointestinal bleeding, in the 3 months before the survey (21.9% versus 6.9%; P<0.05). Both groups reported high medication adherence (dabigatran users 0.65 versus warfarin users 0.63 missed doses/month). Dabigatran users were more likely than warfarin users to discuss treatment options with their physician before beginning therapy (36.9% versus 24.5%; P<0.05) and less likely to switch anticoagulant medication (10.7% versus 31.9%; P<0.05). Although dabigatran users were more likely to experience adverse events, they reported greater satisfaction with anticoagulation treatment than warfarin users.
The efficacy and convenience reported by dabigatran users resulted in greater treatment satisfaction among dabigatran users, even though adverse events decreased it. Treatment strategies that minimize adverse events may improve treatment satisfaction and adherence among patients with atrial fibrillation.
口服达比加群最近被批准作为华法林的替代药物，用于预防非瓣膜性心房颤动患者的中风和全身性栓塞。与华法林不同，达比加群具有固定剂量且药物相互作用较少，并且不需要进行抗凝监测或饮食限制。
本研究旨在描述和比较使用达比加群或仅使用华法林的心房颤动患者的特征。年龄≥18岁且正在接受（或已接受）华法林或达比加群治疗且自我报告诊断为心房颤动的患者完成了一项在线调查。分别使用卡方检验和方差分析对达比加群和华法林使用者的特征差异进行分类变量和连续变量的检验。
总体而言，共调查了364例患者（204例华法林使用者，160例达比加群使用者）。平均年龄为65.1岁，男性占68.7%。达比加群使用者比华法林使用者更可能为女性（36.9%对27.0%），并且在调查前3个月内更有可能经历不良事件，包括胃肠道出血（21.9%对6.9%；P<0.05）。两组均报告药物依从性较高（达比加群使用者每月漏服剂量为0.65次对华法林使用者为0.63次）。达比加群使用者比华法林使用者在开始治疗前更有可能与医生讨论治疗方案（36.9%对24.5%；P<0.05），并且更换抗凝药物的可能性较小（10.7%对31.9%；P<0.05）。尽管达比加群使用者更有可能经历不良事件，但他们报告对抗凝治疗的满意度高于华法林使用者。
达比加群使用者报告的疗效和便利性导致其对治疗的满意度更高，尽管不良事件降低了满意度。尽量减少不良事件的治疗策略可能会提高心房颤动患者的治疗满意度和依从性。
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