Department of Clinical Biochemistry, Regional Hospital of West Jutland, Gl. Landevej 61, Herning, Denmark.
Department of Cardiology, Regional Hospital of West Jutland, Herning, Denmark.
Eur Heart J Cardiovasc Pharmacother. 2019 Apr 1;5(2):91-99. doi: 10.1093/ehjcvp/pvy047.
Effective anticoagulation in patients undergoing electrical cardioversion (ECV) for symptomatic atrial fibrillation is important to prevent adverse events. High medication adherence is a requirement. In patients with newly diagnosed atrial fibrillation (n = 169) who were intended to undergo ECV, the aim of this study was to measure self-reported short- and long-term adherence, evaluate whether dabigatran plasma concentrations reflect adherence, measure treatment satisfaction and assess whether adherence and treatment satisfaction are correlated.
Plasma concentrations (liquid-chromatography tandem mass spectrometry), the 8-point Morisky Medication Adherence Scale (MMAS-8) and the Anti-Clot Treatment Scale (ACTS) were measured after 3 weeks and 7 weeks of treatment. Combined mean peak (1-3 h after intake) and trough (10-16 h after intake) plasma concentrations were 175 (SD 109) ng/mL and 75 (SD 45) ng/mL, respectively. There was no relationship between short-term adherence (last 3 days) or long-term adherence (last 3-4 weeks) and plasma concentrations, unless the last intake was more than 48 h ago. After 7 weeks high, moderate, and low adherence, according to the MMAS-8, was seen in 74%, 21%, and 5% of patients, respectively. Treatment satisfaction was high (median ACTS score 68.5, range 46-75 points). Treatment satisfaction and adherence were not correlated.
The percentage of patients in the high adherence group (74%) was lower than expected, which is a matter of concern. Dabigatran plasma concentrations could not detect short- or long-term non-adherence, unless the drug was last taken more than 48 h ago. Treatment satisfaction did not correlate with adherence.
在行电复律（ECV）治疗有症状的心房颤动（房颤）的患者中，有效的抗凝治疗对于预防不良事件非常重要。高药物依从性是必需的。在拟行 ECV 的新发房颤（n=169）患者中，本研究的目的是测量短期和长期的自我报告依从性，评估达比加群的血浆浓度是否反映依从性，测量治疗满意度，并评估依从性和治疗满意度是否相关。
在治疗的第 3 周和第 7 周后，测量了血浆浓度（液相色谱串联质谱法）、8 点 Morisky 用药依从性量表（MMAS-8）和抗血栓治疗量表（ACTS）。联合的平均峰值（摄入后 1-3 小时）和谷值（摄入后 10-16 小时）血浆浓度分别为 175（SD 109）ng/ml 和 75（SD 45）ng/ml。除非最后一次服药超过 48 小时，否则短期（最后 3 天）或长期（最后 3-4 周）依从性与血浆浓度之间没有关系。7 周后，根据 MMAS-8，高、中、低依从性分别见于 74%、21%和 5%的患者。治疗满意度高（中位数 ACTS 评分 68.5，范围 46-75 分）。治疗满意度和依从性没有相关性。
高依从性组（74%）的患者比例低于预期，这是一个令人关注的问题。除非最后一次服药超过 48 小时，否则达比加群的血浆浓度无法检测到短期或长期的不依从。治疗满意度与依从性无关。
