van de Steeg Bas J W, Esselink Anne C, de Wit Hugo A J M, Kramers Cornelis, van den Bemt Bart J F
Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
Patient Prefer Adherence. 2024 Aug 23;18:1779-1788. doi: 10.2147/PPA.S463164. eCollection 2024.
Arterial and venous thromboembolism are a leading cause of mortality. Direct oral anticoagulants (DOACs) are highly effective in both stroke prevention and prevention of venous thrombotic events. Medication adherence is a prerequisite for optimal protection against thromboembolic complications. Recent studies have shown that good adherence cannot be taken for granted by DOACs. In this cross-sectional study adherence among DOAC users was investigated and associations between beliefs about medication, perceived side effects and adherence were explored.
We included 100 randomly selected adult DOAC users visiting one of the two participating Dutch community pharmacies in the summer of 2020. The self-reported adherence (primary outcome) was assessed with the Medication Adherence Rating Scale-5 (MARS-5) using three different cut-off scores. Beliefs about DOACs were assessed with the Beliefs about Medicine Questionnaire Specific (BMQ-S), while side effects and side effect burden were assessed with a self-developed questionnaire based on the Lareb Intensive Monitoring (LIM) system.
Of the participants, 9% reported non-adherence on the primary MARS-5 cut-off score <24. For the MARS-5 scores <23 and <25 non-adherence percentages of, respectively, 3 and 33% were calculated. Associations were found between adherence and both side effects and side effect burden, regardless of the MARS-5 cut-off score. Bruising and minor bleeds were the most reported side effects (both 20%). For all patients, the necessity beliefs outweighed the concern beliefs. No associations were found between adherence and either gender, indication, DOAC or dosage.
This study confirms that adherence in patients on DOACs cannot be taken for granted. High necessity beliefs do not guarantee good adherence, as side effects impair adherence even in patients having high necessity beliefs. Therefore, we recommend that both physicians and pharmacists evaluate both adherence and side effects with these patients on a regular base.
动脉和静脉血栓栓塞是主要的死亡原因。直接口服抗凝剂（DOACs）在预防中风和静脉血栓形成事件方面都非常有效。药物依从性是预防血栓栓塞并发症的最佳保护的先决条件。最近的研究表明，不能想当然地认为DOACs使用者具有良好的依从性。在这项横断面研究中，调查了DOACs使用者的依从性，并探讨了药物信念、感知到的副作用与依从性之间的关联。
我们纳入了2020年夏天随机选择的100名成年DOACs使用者，他们前往两家参与研究的荷兰社区药房之一就诊。使用药物依从性评定量表-5（MARS-5），通过三种不同的临界值来评估自我报告的依从性（主要结局）。使用特定药物信念问卷（BMQ-S）评估对DOACs的信念，而使用基于拉勒布强化监测（LIM）系统自行编制的问卷评估副作用和副作用负担。
在参与者中，9%的人在主要MARS-5临界值<24时报告不依从。对于MARS-5分数<23和<25的情况，不依从百分比分别计算为3%和33%。无论MARS-5临界值如何，均发现依从性与副作用及副作用负担之间存在关联。瘀伤和轻微出血是报告最多的副作用（均为20%）。对于所有患者，必要性信念超过了担忧信念。未发现依从性与性别、适应症、DOAC或剂量之间存在关联。
本研究证实，不能想当然地认为DOACs患者具有良好的依从性。高必要性信念并不能保证良好的依从性，因为即使在具有高必要性信念的患者中，副作用也会损害依从性。因此，我们建议医生和药剂师定期评估这些患者的依从性和副作用。
