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Secondary adherence to non-vitamin-K antagonist oral anticoagulants in patients with atrial fibrillation in Sweden and the Netherlands
Univ Groningen, Netherlands; Martini Hosp, Netherlands.
Univ Groningen, Netherlands.
Univ Groningen, Netherlands.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
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2018 (English)In: Current Medical Research and Opinion, ISSN 0300-7995, E-ISSN 1473-4877, Vol. 34, no 10, p. 1839-1847Article in journal (Refereed) Published
Abstract [en]

Objective: There is limited evidence on patients adherence and the impact of the prescribed dosing regimen in non-vitamin-K oral anticoagulants (NOACs). We aimed to assess secondary adherence to NOACs and to determine the impact of the dosing regimen in patients with atrial fibrillation. Methods: Patients using a NOAC between 2009 and 2013 were identified from the nation-wide Swedish Prescribed Drug Register and the Dutch regional IADB.nl database. Patients using a consistent dosage for at least 180 consecutive days were included. Adherence was calculated using the medication possession ratio (MPR) and adjusted for overlapping dates. Adherence was defined as a MPR amp;gt;= 0.8. Sensitivity analyses were performed using a MPR amp;gt;= 0.9. Logistic regression was performed to compare secondary adherence and to explore the influence of the dosing regimen. Results: A total of 5254 Swedish and 430 Dutch NOAC users were included. The mean MPR was 96.0% (SD 7.8%) in Sweden and 95.1% (SD 10.1%) in the Netherlands. Multivariable logistic regression analysis showed that a twice daily regimen had a lower likelihood of being secondary adherent compared to a once daily regimen in Sweden (odds ratio [OR] 0.21 [95% CI 0.12-0.35]). Limitations: The influence of selection bias introduced by the inclusion criterion of amp;gt;= 2 dispensations covering at least 180 days could not be excluded. Conclusions: This study demonstrated that secondary adherence was high in this specific setting among patients with at least two initial dispensations of a NOAC covering a minimum of 180 days. The use of NOACs in a once daily regimen showed higher adherence compared to a twice daily regimen.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2018. Vol. 34, no 10, p. 1839-1847
Keywords [en]
Adherence; non-vitamin-K oral anticoagulants; anticoagulation; dosing regimen; apixaban; dabigatran; rivaroxaban
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Dermatology and Venereal Diseases
Identifiers
URN: urn:nbn:se:liu:diva-151809DOI: 10.1080/03007995.2018.1459528ISI: 000444253800017PubMedID: 29598152OAI: oai:DiVA.org:liu-151809DiVA, id: diva2:1253257
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-10-04

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Hoffmann, MikaelLevin, Lars-Åke
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