Institute of Pharmaceutical Science, King's College London, London, United Kingdom; King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Institute of Pharmaceutical Science, King's College London, London, United Kingdom; King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Thromb Res. 2021 Dec;208:162-169. doi: 10.1016/j.thromres.2021.11.003. Epub 2021 Nov 15.
Switching non-adherent patients prescribed anticoagulant treatment to a regime with less monitoring could lead to significant non-adherence. Health beliefs are known to influence medication adherence; however, the extent of this influence is unknown in patients switched from vitamin-K antagonists (VKAs) to direct oral anticoagulants (DOACs). This study aimed to determine adherence to long-term therapy in patients switched from VKAs to DOAC due to low time in therapeutic range (TTR) and if adherence is associated with health beliefs.
The Switching Study is a longitudinal observational cohort study following patients for at least 1-year. 254 patients anticoagulated with VKAs for stroke prevention in atrial fibrillation (AF) or secondary prevention of venous thromboembolism (VTE) and TTR < 50% were recruited from anticoagulation clinics at King's College Hospital, London, UK. All participants were switched to DOAC and had health beliefs measured at baseline with VKA, 1-month and 12-months after switching.
Of the 220 patients who completed 12-month follow-up 39% had sub-optimal adherence measured by self-report. 23% were non-adherent according to prescriptions issued. Increasing concerns about anticoagulation over time relative to beliefs about necessity was associated with lower self-reported adherence (OR = 0.902 95%C.I: 0.836, 0.974; p = 0.008). At baseline, believing that medications in general were overused in healthcare was negatively associated with adherence to DOAC (β = -1.5, 95%C.I: -2.7, -0.3; p = 0.013).
Although many patients who switched were adherent to therapy long-term, between 23 and 39% of patients exhibited sub-optimal adherence: these patients can be identified through their modifiable health beliefs at the time of switching.
将服用抗凝药物但不遵医嘱的患者转为监测要求较低的治疗方案可能导致显著的不遵医嘱行为。健康信念已知会影响药物依从性；然而，在从维生素 K 拮抗剂 (VKA) 转为直接口服抗凝剂 (DOAC) 的患者中，这种影响的程度尚不清楚。本研究旨在确定因治疗时间范围 (TTR) 较低而从 VKA 转为 DOAC 的患者长期治疗的依从性，以及依从性是否与健康信念相关。
Switching 研究是一项纵向观察队列研究，至少随访患者 1 年。该研究从英国伦敦国王学院医院的抗凝门诊招募了 254 名因心房颤动 (AF) 中风预防或静脉血栓栓塞症 (VTE) 二级预防而服用 VKA 且 TTR<50%的患者。所有患者均转为 DOAC，并在基线、VKA 转换后 1 个月和 12 个月时测量健康信念。
在完成 12 个月随访的 220 名患者中，39%的患者自我报告依从性不佳。根据开出的处方，23%的患者不遵医嘱。随着时间的推移，对抗凝的担忧相对于对必要性的信念增加与自我报告的依从性降低相关 (OR=0.902 95%CI：0.836，0.974；p=0.008)。在基线时，认为一般药物在医疗保健中被过度使用与对 DOAC 的依从性呈负相关 (β=−1.5，95%CI：−2.7，−0.3；p=0.013)。
尽管许多转为 DOAC 的患者长期依从性良好，但仍有 23%至 39%的患者表现出依从性不佳：这些患者可以通过其在转换时可改变的健康信念来识别。
