Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 2, pp 139–144 | Cite as

Predictors of self-reported adherence to direct oral anticoagulation in a population of elderly men and women with non-valvular atrial fibrillation

  • Andrea P. Rossi
  • Roberto Facchinetti
  • Elena Ferrari
  • Nicole Nori
  • Selena Sant
  • Elena Masciocchi
  • Elena Zoico
  • Francesco Fantin
  • Gloria Mazzali
  • Mauro Zamboni


There is a general lack of studies evaluating medication adherence with self-report scales for elderly patients in treatment with direct oral anticoagulants (DOACs). The aim of the study was to assess the degree of adherence to DOAC therapy in a population of elderly outpatients aged 65 years or older affected by non-valvular atrial fibrillation (NVAF), using the 4-item Morisky Medication Adherence Scale, and to identify potential factors, including the geriatric multidimensional evaluation, which can affect adherence in the study population. A total of 103 subjects, anticoagulated with DOACs for NVAF in primary or secondary prevention, were eligible; 76 showed adequate adhesion to anticoagulant therapy, while 27 showed inadequate adherence. Participants underwent biochemical assessment and Morisky Scale, Instrumental Activities of Daily Living, CHA2DS2-VASc, HAS-BLED, mental status and nutritional evaluations were performed. 2% of subjects assumed Dabigatran at low dose, while 7.8% at standard dose, 9.7% assumed low-dose of Rivaroxaban and 30.1% at standard dose, 6.8% assumed Apixaban at low dose and 39.7% at standard dose, and finally 1% assumed Edoxaban at low dose and 2.9% at standard dose. Most subjects took the DOACs without help (80.6%), while 16 subjects were helped by a family member (15.5%) and 4 were assisted by a caregiver (3.9%). Binary logistic regression considered inappropriate adherence as a dependent variable, while age, male sex, polypharmacotherapy, cognitive decay, caregiver help for therapy assumption, duration of DOAC therapy and double daily administration were considered as independent variables. The double daily administration was an independent factor, determining inappropriate adherence with an OR of 2.88 (p = 0.048, CI 1.003–8.286).


Atrial fibrillation Direct anticoagulants Adherence Elderly 



Direct oral anticoagulants


Non-valvular atrial fibrillation


Alanine aminotransferase


Short Portable Status Mental Questionnaire


Geriatric Depression Scale


Activities of Daily Living


Instrumental Activities of Daily Living


Mini Nutritional Assessment


Odds ratio


Confidence interval


Vitamin K antagonists


Congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or TIA.


Hypertension, abnormal renal or liver function, stroke, bleeding, labile INR, elderly


Standard deviations


Analysis of variance


Morisky medication adherence scale


Time in therapeutic range



The authors’ responsibilities were as follows—AR, RF, EF: analysis and interpretation of data and preparation of manuscript; EZ, FF, MZ: edited the manuscript, AR, RF, EF, SS, NN, EM, FF, GM: study concept and design, acquisition of subjects, collection of data, and review of the manuscript. The manuscript has been revised extensively by a native English speaker and medical writer, Prof. Mark J Newman.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Andrea P. Rossi
    • 1
    • 2
  • Roberto Facchinetti
    • 3
  • Elena Ferrari
    • 1
    • 2
  • Nicole Nori
    • 1
    • 2
  • Selena Sant
    • 1
    • 2
  • Elena Masciocchi
    • 1
    • 2
  • Elena Zoico
    • 1
    • 2
  • Francesco Fantin
    • 1
    • 2
  • Gloria Mazzali
    • 1
    • 2
  • Mauro Zamboni
    • 1
    • 2
  1. 1.Division of GeriatricsUniversity of VeronaVeronaItaly
  2. 2.Healthy Aging Center VeronaVeronaItaly
  3. 3.Laboratorio di analisi e Centro FCSA di VeronaVeronaItaly

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