Emren Sadık Volkan, Şenöz Oktay, Bilgin Murat, Beton Osman, Aslan Abdullah, Taşkin Uğur, Açiksari Gönül, Asarcikli Lale Dinç, Çakir Hakan, Bekar Lütfü, Bolat İsmail, Yayla Çağrı, Çelebi Barış, Dalgiç Onur, Çelik Oğuzhan, Şafak Özgen, Akyel Serdar, Güngör Hasan, Düzel Barış, Zoghi Mehdi
1 Department of Cardiology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey.
2 Department of Cardiology, Artvin State Hospital, Artvin, Turkey.
Clin Appl Thromb Hemost. 2018 Apr;24(3):525-531. doi: 10.1177/1076029617693940. Epub 2017 Feb 19.
Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 ± 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P = .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.
坚持服用非维生素K拮抗剂口服抗凝药（NOACs）是确保非瓣膜性心房颤动（NVAF）疗效和安全性的重要因素。关于现实世界数据中的NOAC依从性存在有争议的结果，并且在土耳其人群中没有关于NOAC依从性的数据。本研究基于自我报告调查了NOAC依从性、影响不依从的因素以及依从水平与疗效和安全性结果的关系。这项多中心横断面研究纳入了2738例患者（59%为女性），这些患者因NVAF使用NOAC（达比加群、阿哌沙班和利伐沙班）超过3个月，且在2015年9月1日至2016年2月28日期间有超过30天的药物供应。为了测量依从水平，使用了一个8项的Morisky药物依从性量表。患者的平均年龄为70±10岁。在2738例患者中，44%接受达比加群，38%接受利伐沙班，18%接受阿哌沙班。共有630例（23%）患者药物依从性高，712例（26%）中度依从，1396例（51%）低度依从。不依从与中风（5.6%对2.5%，P<.001）以及轻微（21.2%对11.1%，P<.001）和严重（6.1%对3.7%，P=.004）出血率相关。在土耳其，发现对NOAC的依从性相当低。不依从与出血和血栓栓塞性心血管事件相关。年龄、每天服用两次NOAC以及其他非心脏疾病、抑郁症和痴呆是影响药物依从性差的独立因素。
