Adherence to warfarin treatment among patients with atrial fibrillation
Tóm tắt
Treatment with warfarin greatly reduces the risk of stroke related to atrial fibrillation, but will not be effective unless patients adhere to treatment. Lack of fixed dosing makes it difficult to objectively estimate adherence to treatment from prescription data. To evaluate two methods that assess adherence to warfarin from prescription data. Retrospective study of Swedish health care registers. Age- and sex-specific dose requirements were determined from approx. 1 million blood tests and dosing instructions. By applying these dosages to 163,785 warfarin-treated patients with atrial fibrillation, we calculated the quantity of warfarin that was needed to keep these patients on effective treatment during a mean follow-up of 3.9 years and compared that with the dispensed quantities. The ratio of available drug/time at risk constitutes a measure of adherence on group level. In addition, time intervals between refills were used to assess discontinuation. Both methods showed that 45 % of the patients did not have enough warfarin to last 80 % of the time at risk. Between 16 and 21 % of the patients discontinued within the first year, followed by 8–9 % annually during the following years. Patients with high bleeding risk and patients with low embolic risk showed lower endurance. Adherence to treatment with warfarin can be estimated on group level from prescription data and may be useful for comparison of adherence with warfarin and new oral anticoagulants. When applied to a large warfarin-treated cohort with atrial fibrillation, we found that adherence is low and that measures aiming for improvements are needed
.
Tài liệu tham khảo
Camm AJ, Lip GY, De Caterina R et al (2012) 2012 focused update of the esc guidelines for the management of atrial fibrillation: An update of the 2010 esc guidelines for the management of atrial fibrillation developed with the special contribution of the european heart rhythm association. Europace 14:1385–1413
Aguilar MI, Hart R (2005) Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database Syst Rev 3:CD001927
Rosendaal FR, Cannegieter SC, van der Meer FJ et al (1993) A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 69:236–239
Connolly SJ, Pogue J, Eikelboom J et al (2008) Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation 118:2029–2037
Morgan CL, McEwan P, Tukiendorf A et al (2009) Warfarin treatment in patients with atrial fibrillation: observing outcomes associated with varying levels of INR control. Thromb Res 124:37–41
Wallentin L, Yusuf S, Ezekowitz MD et al (2010) Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 376:975–983
Patel MR, Mahaffey KW, Garg J et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New Eng J Med 365:883–891
Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. New Eng J Med 361:1139–1151
Granger CB, Alexander JH, McMurray JJ et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. New Eng J Med 365:981–992
Jorgensen AL, Hughes DA, Hanson A et al (2013) Adherence and variability in warfarin dose requirements: assessment in a prospective cohort. Pharmacogenomics 14:151–163
Sappok T, Faulstich A, Stuckert E et al (2001) Compliance with secondary prevention of ischemic stroke: a prospective evaluation. Stroke 32:1884–1889
Hamann GF, Weimar C, Glahn J et al (2003) Adherence to secondary stroke prevention strategies–results from the german stroke data bank. Cerebrovasc Dis 15:282–288
De Schryver EL, van Gijn J, Kappelle LJ et al (2005) Non-adherence to aspirin or oral anticoagulants in secondary prevention after ischaemic stroke. J Neurol 252:1316–1321
Gomes T, Mamdani MM, Holbrook AM et al (2012) Persistence with therapy among patients treated with warfarin for atrial fibrillation. Arch Intern Med 172:1687–1689
Maxwell W, Bennett CL (2012) Will newer anticoagulants improve therapy persistence? Arch Intern Med 172:1689–1690
Wang Y, Kong MC, Ko Y (2013) Comparison of three medication adherence measures in patients taking warfarin. J Thromb Thrombol 36:416–421
Auricula. In: Auricula annual report 2011 [auricula årsrapport 2011]. UCR, Uppsala Clinical Research Center 2013, http://www.ucr.uu.se/auricula/index.php/arsrapporter. Accessed 23 Jan 2014
Mattson ME, Friedman LM (1984) Issues in medication adherence assessment in clinical trials of the national heart, lung, and blood institute. Controll Clin Trial 5:488–496
Kimmel SE, Chen Z, Price M et al (2007) The influence of patient adherence on anticoagulation control with warfarin: results from the international normalized ratio adherence and genetics (in-range) study. Arch Intern Med 167:229–235
Yeaw J, Benner JS, Walt JG et al (2009) Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm 15:728–740
Ewen S, Rettig-Ewen V, Mahfoud F et al (2014) Drug adherence in patients taking oral anticoagulation therapy. Clin Res Cardiol 103:173–182
Hylek EM, Evans-Molina C, Shea C et al (2007) Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 115:2689–2696
Glader EL, Sjölander M, Eriksson M et al (2010) Persistent use of secondary preventive drugs declines rapidly during the first 2 years after stroke. Stroke 41:397–401
White HD, Gruber M, Feyzi J et al (2007) Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med 167:239–245
Nieuwlaat R, Connolly BJ, Hubers LM, ACTIVE Investigators et al (2012) Quality of individual INR control and the risk of stroke and bleeding events in atrial fibrillation patients: a nested case control analysis of the ACTIVE W study. Thromb Res 129:715–719
Casciano JP, Dotiwala ZJ, Martin BC et al (2013) The costs of warfarin underuse and nonadherence in patients with atrial fibrillation: a commercial insurer perspective. J Manag Care Pharm 19:302–316