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Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation

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Autor
Tiili P., Leventis I., Kinnunen J., Svedjebäck I., Lehto M., Karagkiozi E., Sagris D., Ntaios G., Putaala J.
Fecha
2021
Language
en
DOI
10.1080/07853890.2021.1968031
Materia
anticoagulant agent
antidiabetic agent
antihypertensive agent
antithrombocytic agent
antivitamin K
apixaban
dabigatran
edoxaban
hydroxymethylglutaryl coenzyme A reductase inhibitor
low molecular weight heparin
rivaroxaban
warfarin
anticoagulant agent
age
aged
anticoagulant therapy
Article
atrial fibrillation
CHA2DS2-VASc score
clinical feature
comorbidity
controlled study
cross-sectional study
demography
female
HAS BLED score
hospital patient
human
ischemic stroke
major clinical study
male
medication compliance
Mini Mental State Examination
negligence
patient compliance
patient-reported outcome
sex
smoking
structured questionnaire
telephone interview
tertiary education
atrial fibrillation
brain ischemia
cerebrovascular accident
child
complication
medication compliance
oral drug administration
preschool child
prospective study
psychology
Administration, Oral
Anticoagulants
Atrial Fibrillation
Brain Ischemia
Child
Child, Preschool
Female
Humans
Ischemic Stroke
Male
Medication Adherence
Prospective Studies
Stroke
Taylor and Francis Ltd.
Mostrar el registro completo del ítem
Resumen
Background: 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. Aims: 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). Methods: 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 CHA2DS2-VASc and SAMe-TT2R2 scores with poor adherence. Results: 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. CHA2DS2-VASc and SAMe-TT2R2 scores were not associated with poor adherence. Conclusions: 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 MESSAGES Adherence 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. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
URI
http://hdl.handle.net/11615/79709
Colecciones
  • Δημοσιεύσεις σε περιοδικά, συνέδρια, κεφάλαια βιβλίων κλπ. [19735]

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