Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation

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Tiili , P , Leventis , I , Kinnunen , J , Svedjebäck , I , Lehto , M , Karagkiozi , E , Sagris , D , Ntaios , G & Putaala , J 2021 , ' Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation ' , Annals of Medicine , vol. 53 , no. 1 , pp. 1613-1620 .

Title: Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation
Author: Tiili, Paula; Leventis, Ioannis; Kinnunen, Janne; Svedjebäck, Ida; Lehto, Mika; Karagkiozi, Efstathia; Sagris, Dimitrios; Ntaios, George; Putaala, Jukka
Contributor organization: Neurologian yksikkö
HUS Neurocenter
Staff Services
HUS Heart and Lung Center
Kardiologian yksikkö
Department of Neurosciences
University of Helsinki
Date: 2021-01-01
Language: eng
Number of pages: 8
Belongs to series: Annals of Medicine
ISSN: 0785-3890
Abstract: 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 CHA(2)DS(2)-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. CHA(2)DS(2)-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.
Subject: Atrial fibrillation
ischaemic stroke
oral anticoagulation
3124 Neurology and psychiatry
Peer reviewed: Yes
Rights: cc_by_nc
Usage restriction: openAccess
Self-archived version: publishedVersion

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