Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation

Paula Tiili; Ioannis Leventis; Janne Kinnunen; Ida Svedjebäck; Mika Lehto; Efstathia Karagkiozi; Dimitrios Sagris; George Ntaios; Jukka Putaala

doi:10.1080/07853890.2021.1968031

Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation

Ann Med. 2021 Dec;53(1):1613-1620. doi: 10.1080/07853890.2021.1968031.

Authors

Paula Tiili¹, Ioannis Leventis², Janne Kinnunen¹, Ida Svedjebäck¹, Mika Lehto^{3

4}, Efstathia Karagkiozi², Dimitrios Sagris², George Ntaios², Jukka Putaala¹

Affiliations

¹ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
² Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
³ Lohja Hospital, Department of Internal Medicine, Helsinki, Finland.
⁴ Department of Cardiology, Helsinki University Hospital, Helsinki, Finland.

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 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 MESSAGESAdherence 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.

Keywords: Atrial fibrillation; adherence; ischaemic stroke; oral anticoagulation; persistence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Oral
Anticoagulants / therapeutic use
Atrial Fibrillation / complications
Atrial Fibrillation / drug therapy*
Atrial Fibrillation / epidemiology
Brain Ischemia / drug therapy*
Brain Ischemia / epidemiology
Brain Ischemia / prevention & control
Child
Child, Preschool
Female
Humans
Ischemic Stroke / drug therapy*
Male
Medication Adherence / psychology*
Prospective Studies
Stroke / epidemiology
Stroke / etiology
Stroke / prevention & control

Substances

Anticoagulants

Grants and funding

The study conduct was funded with a non-restricted competitive grant from the Bristol-Myers Squibb/Pfizer European Thrombosis Investigator-Initiated Research Program (ERISTA). The company had no role in study planning, conduct, data analysis, or drafting the manuscript.