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Drug adherence in patients taking oral anticoagulation therapy

Abstract

Oral anticoagulation has proven to reduce mortality and morbidity of thromboembolic events. One of the most important determinants of the effectiveness and safety of anticoagulation therapy is the adherence to the prescribed therapy. Vitamin K antagonists are characterized by under-utilization, a narrow therapeutic window and multiple food and drug interactions which contribute to a variable dose–response relationship with the risk of insufficient protection and/or increased bleeding risk. The “new” direct oral anticoagulants have demonstrated equal or superior protection and reduced bleeding risks compared to warfarin and are easier to use because of fixed dosing without monitoring of anticoagulation. Controlling of adherence to the direct oral anticoagulants is difficult. Therefore, continuous and regular medication intake represents a pre-requisite for achieving optimal protection. The present review aims to give an overview about the factors that affect drug adherence in patients taking oral anticoagulation drugs and discusses strategies to improve drug adherence.

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Abbreviations

AF:

Atrial fibrillation

bid:

Twice a day

cTTR:

Center TTR

INR:

International normalized ratio

iTTR:

Individual time in therapeutic range

NOACs:

New oral anticoagulants

OAC:

Oral anticoagulation

qd:

Once a day

TTR:

Time in therapeutic range

VKA:

Vitamin K antagonists

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Ewen, S., Rettig-Ewen, V., Mahfoud, F. et al. Drug adherence in patients taking oral anticoagulation therapy. Clin Res Cardiol 103, 173–182 (2014). https://doi.org/10.1007/s00392-013-0616-8

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Keywords

  • Demographic development
  • Polypharmacy
  • Drug adherence
  • Oral anticoagulation
  • New oral anticoagulants