Division of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy.
Healthy Aging Center Verona, Verona, Italy.
J Thromb Thrombolysis. 2018 Aug;46(2):139-144. doi: 10.1007/s11239-018-1679-1.
There is a general lack of studies evaluating medication adherence with self-report scales for elderly patients in treatment with direct oral anticoagulants (DOACs). The aim of the study was to assess the degree of adherence to DOAC therapy in a population of elderly outpatients aged 65 years or older affected by non-valvular atrial fibrillation (NVAF), using the 4-item Morisky Medication Adherence Scale, and to identify potential factors, including the geriatric multidimensional evaluation, which can affect adherence in the study population. A total of 103 subjects, anticoagulated with DOACs for NVAF in primary or secondary prevention, were eligible; 76 showed adequate adhesion to anticoagulant therapy, while 27 showed inadequate adherence. Participants underwent biochemical assessment and Morisky Scale, Instrumental Activities of Daily Living, CHA2DS2-VASc, HAS-BLED, mental status and nutritional evaluations were performed. 2% of subjects assumed Dabigatran at low dose, while 7.8% at standard dose, 9.7% assumed low-dose of Rivaroxaban and 30.1% at standard dose, 6.8% assumed Apixaban at low dose and 39.7% at standard dose, and finally 1% assumed Edoxaban at low dose and 2.9% at standard dose. Most subjects took the DOACs without help (80.6%), while 16 subjects were helped by a family member (15.5%) and 4 were assisted by a caregiver (3.9%). Binary logistic regression considered inappropriate adherence as a dependent variable, while age, male sex, polypharmacotherapy, cognitive decay, caregiver help for therapy assumption, duration of DOAC therapy and double daily administration were considered as independent variables. The double daily administration was an independent factor, determining inappropriate adherence with an OR of 2.88 (p = 0.048, CI 1.003-8.286).
目前，针对使用直接口服抗凝剂（DOAC）治疗的老年患者，采用自我报告量表评估药物依从性的研究普遍缺乏。本研究旨在使用 Morisky 药物依从性量表评估年龄在 65 岁及以上的非瓣膜性心房颤动（NVAF）老年门诊患者对 DOAC 治疗的依从程度，并确定可能影响研究人群药物依从性的因素，包括老年多维评估。共有 103 名接受 DOAC 治疗 NVAF 一级或二级预防的患者符合条件；76 名患者抗凝治疗依从性良好，27 名患者抗凝治疗依从性不佳。参与者接受了生化评估和 Morisky 量表、工具性日常生活活动、CHA2DS2-VASc、HAS-BLED、精神状态和营养评估。2%的患者接受低剂量达比加群治疗，7.8%接受标准剂量治疗，9.7%接受低剂量利伐沙班治疗，30.1%接受标准剂量治疗，6.8%接受低剂量阿哌沙班治疗，39.7%接受标准剂量治疗，最后 1%接受低剂量依度沙班治疗，2.9%接受标准剂量治疗。大多数患者（80.6%）无需帮助即可服用 DOACs，16 名患者（15.5%）需要家庭成员帮助，4 名患者（3.9%）需要护理人员帮助。二元逻辑回归将不适当的依从性视为因变量，而年龄、男性、多药治疗、认知衰退、护理人员对治疗的帮助、DOAC 治疗持续时间和每日两次给药被视为自变量。每日两次给药是一个独立因素，决定不适当的依从性的 OR 为 2.88（p=0.048，95%CI 1.003-8.286）。
