Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Ann Med. 2021 Dec;53(1):1613-1620. doi: 10.1080/07853890.2021.1968031.
Non-vitamin K antagonist oral anticoagulants (NOAC) have superior safety and comparable efficacy profile compared to vitamin-K antagonists (VKAs), with more convenient dosing schemes. However, issues with adherence to the NOACs remain unsolved.
We sought to investigate the adherence to oral anticoagulation (OAC) and baseline factors associated with poor adherence after ischaemic stroke in patients with atrial fibrillation (AF).
We recruited hospitalised patients (2013-2019) from two prospective stroke registries in Larissa and Helsinki University Hospitals and invited survived patients to participate in a telephone interview. We assessed adherence with the Adherence to Refills and Medications Scale (ARMS) and defined poor adherence as a score of over 17. In addition to demographics, individual comorbidities, and stroke features, we assessed the association of CHADS-VASc and SAMe-TTR scores with poor adherence.
Among 396 patients (median age 75.0 years, interquartile range [IQR] 70-80; 57% men; median time from ischaemic stroke to interview 21 months [IQR 12-33]; median ARMS score 17 [IQR 17-19]), 56% of warfarin users and 44% of NOAC users reported poor adherence. In the multivariable regression model adjusted for site, sex, and age, poor adherence was independently associated with tertiary education, absence of heart failure, smoking history, use of VKA prior to index stroke, and prior ischaemic stroke. CHADS-VASc and SAMe-TTR scores were not associated with poor adherence.
Adherence was poor in half of AF patients who survived an ischaemic stroke. Independent patient-related factors, rather than composite scores, were associated with poor adherence in these patients.KEY MESSAGESAdherence was poor in half of the atrial fibrillation patients who survived an ischaemic stroke.Independent patient-related factors rather than composite scores were associated with poor adherence.The findings support the importance of recognising adherence support as a crucial part of holistic patient care recommended by recent AF guideline.
与维生素 K 拮抗剂（VKA）相比，新型口服抗凝剂（NOAC）具有更好的安全性和相当的疗效，且给药方案更方便。然而，NOAC 依从性问题仍未得到解决。
我们旨在研究缺血性卒中和心房颤动（AF）后影响 NOAC 抗凝治疗依从性的相关因素。
我们从拉里萨和赫尔辛基大学医院的两个前瞻性卒中登记处招募住院患者（2013-2019 年），并邀请幸存患者参加电话访谈。我们使用药物依从性量表（ARMS）评估患者的依从性，得分超过 17 分为依从性差。除了人口统计学、个体合并症和卒中特征外，我们还评估了 CHADS-VASc 和 SAMe-TTR 评分与依从性差的相关性。
在 396 例患者中（中位年龄 75.0 岁，四分位距 [IQR] 70-80；57%为男性；从缺血性卒中和访谈中位时间 21 个月 [IQR 12-33]；ARMS 评分中位数为 17 [IQR 17-19]），56%的华法林使用者和 44%的 NOAC 使用者报告依从性差。在校正地点、性别和年龄后，多变量回归模型显示，较差的依从性与高等教育、无心力衰竭、吸烟史、指数卒中前使用 VKA 和既往缺血性卒中相关。CHADS-VASc 和 SAMe-TTR 评分与依从性差无关。
在幸存的缺血性卒中 AF 患者中，有一半的患者依从性较差。与这些患者的依从性较差相关的是独立的患者相关因素，而不是复合评分。这些发现支持了认识到依从性支持是最近的 AF 指南推荐的整体患者护理的重要组成部分的重要性。
