Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Br J Clin Pharmacol. 2022 Nov;88(11):4688-4707. doi: 10.1111/bcp.15437. Epub 2022 Jul 13.
Nonadherence to thromboprophylaxis treatment with oral anticoagulants (OAC) is a public health problem and may be associated with high mortality rates. We sought to synthesize the factors associated with nonadherence to therapy with coumarin derivatives or direct oral anticoagulants. A systematic review was performed at electronic databases Medline, Embase, CINAHL, Lilacs and grey literature (Google Scholar, MedNar, OpenGray, ProQuest Dissertations and Theses, and hand search). This study was conducted according to Cochrane's method and PRISMA. The registration on PROSPERO is CRD42020223555. Overall, 1270 studies were identified and nine studies were selected for this review. In hand searching, 77 studies were found, but none included. The associated factors with nonadherence were heterogeneous, and some factors were described as both risk and protection for nonadherence, with few variables showing consistent results among the studies. Variables reported only as risk factors were "male sex", "hospitalization", "Charlson score" and "bleeding", while "white race", CHA DS VASc (score range 2-9)" and "polypharmacy" were reported only as protective factors. Most studies did not present details in the description of concepts and methods to assess nonadherence. In clinical practice, the knowledge on factors associated with nonadherence is helpful to identifying patients at higher risk of complications that would benefit from individualized interventions.
口服抗凝剂（OAC）的抗血栓治疗不依从是一个公共卫生问题，可能与高死亡率有关。我们旨在综合与香豆素衍生物或直接口服抗凝剂治疗不依从相关的因素。在电子数据库 Medline、Embase、CINAHL、Lilacs 和灰色文献（Google Scholar、MedNar、OpenGray、ProQuest Dissertations and Theses 和手工检索）中进行了系统评价。本研究按照 Cochrane 的方法和 PRISMA 进行。PROSPERO 注册号为 CRD42020223555。共确定了 1270 项研究，其中 9 项研究入选本综述。在手工检索中，发现了 77 项研究，但均未入选。不依从的相关因素存在异质性，有些因素既被描述为不依从的风险因素，也被描述为保护因素，很少有变量在研究中显示出一致的结果。仅被报道为风险因素的变量是“男性”、“住院”、“Charlson 评分”和“出血”，而“白种人”、CHA DS VASc（评分范围 2-9）和“多种药物治疗”仅被报道为保护因素。大多数研究在描述评估不依从的概念和方法时没有提供细节。在临床实践中，了解与不依从相关的因素有助于识别出并发症风险较高的患者，这些患者可能受益于个体化干预。
