Rivera-Caravaca José Miguel, Esteve-Pastor María Asunción, Roldán Vanessa, Marín Francisco, Lip Gregory Y H
a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK.
b Department of Hematology and Clinical Oncology , Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca) , Murcia , Spain.
Expert Opin Drug Saf. 2017 Sep;16(9):1051-1062. doi: 10.1080/14740338.2017.1351542. Epub 2017 Jul 12.
Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) are at least as effective as vitamin K antagonists (VKAs) reducing thromboembolism and mortality in atrial fibrillation (AF). These 'fixed-dose regimen' drugs are characterized by not requiring routine monitoring or dosage adjustment. Stroke prevention with OAC is indicated in AF patients with CHADS-VASc ≥2 (≥3 in females) and NOACs are recommended in preference to VKAs. However, underuse, premature discontinuation of treatment and non-adherence to guidelines is common, and independently associated with higher stroke risk and all-cause mortality. Areas covered: In this review, we provide an overview of the impact of under or overdosing NOACs in AF patients. We debate the current adherence to AF-guidelines, the reasons involved in non-adherence and discontinuation, as well as the limitations found by patients and physicians about the use of NOACs. Expert opinion: The more convenient non-monitored and fixed-dose regimen of NOACs might improve patients' adherence but may hinder the identification of patients with poor adherence or discontinuation. Since there are several reasons for OAC underuse, future strategies to improve adherence should be implemented, that include more and better education about AF and stroke risk, as well as and specific information about the potential consequences of non-adherence to OAC.
非维生素K拮抗剂口服抗凝药（NOACs）在降低心房颤动（AF）患者的血栓栓塞和死亡率方面至少与维生素K拮抗剂（VKAs）一样有效。这些“固定剂量方案”药物的特点是不需要常规监测或剂量调整。CHADS-VASc评分≥2（女性≥3）的AF患者需要使用口服抗凝药（OAC）进行卒中预防，推荐优先使用NOACs而非VKAs。然而，药物使用不足、过早停药以及不遵循指南的情况很常见，并且与更高的卒中风险和全因死亡率独立相关。涵盖领域：在本综述中，我们概述了AF患者使用NOACs不足或过量的影响。我们讨论了目前对AF指南的遵循情况、不遵循和停药的原因，以及患者和医生在使用NOACs时发现的局限性。专家意见：NOACs更方便的无需监测的固定剂量方案可能会提高患者的依从性，但可能会阻碍识别依从性差或停药的患者。由于OAC使用不足有多种原因，未来应实施改善依从性的策略，包括对AF和卒中风险进行更多、更好的教育，以及关于不遵循OAC治疗潜在后果的具体信息。
