Preview

Russian Journal of Cardiology

Advanced search

Contribution of anticoagulant therapy adherence to the risk of complications of atrial fibrillation

https://doi.org/10.15829/1560-4071-2019-2-64-69

Abstract

Aim. To study compliance and its role in the development of the fatal complications of anticoagulant therapy in patients with atrial fibrillation (AF).

Material and methods. Antithrombotic therapy and compliance were studied in an open observational controlled prospective study with 109 AF patients. The dynamics and presence of thromboembolic and hemorrhagic complications were recorded.

Results. For the first time in patients with AF, we detected a significantly high relative risk of development of life-threatening and lethal complications of anticoagulant therapy with warfarin with insufficient compliance (RR=8,0; [1,728;37,027]; p<0,05) and drug therapy (RR=70; [1,493;32,819]; p<0,05). At the same time, patients with AF could not detect any links between the level compliance and the risk of treatment with directly acting oral anticoagulants (DAOC) — patients who achieved a common primary endpoint had no association between the relative risk and the level of compliance (RR=1,0; [0,106;9,445]; p<0,05).

Conclusion. The study showed for the first time that in patients with AF, the most unfavorable prognostic factor in the development of life-threatening and lethal complications with warfarin taking is low adherence to lifestyle modification and drug therapy. At the same time, in patients with AF, who receive DAOK as anticoagulants, there was no connection between compliance and the development of hemorrhagic or thromboembolic complications.

About the Authors

Yu. P. Skirdenko
Omsk State Medical University
Russian Federation

Competing Interests:

nothing to declare



N. A. Nikolaev
Omsk State Medical University
Russian Federation

Competing Interests:

nothing to declare



References

1. ESC Guidelines for the management of atrial fibrillation 2016. doi: 10.1093/eurheartj/ehw210ehw210.

2. Ten CH. New oral anticoagulants: discussion on monitoring and adherence should start now! Thromb J. 2013;11(1):8. doi:10.1186/1477-9560-11-8.

3. Gallagher A, Rietbrock S, Plumb J, et al. Initiation and persistence of warfarin or aspirin in patients with chronic atrial fibrillation in general practice: do the appropriate patients receive stroke prophylaxis? J Thromb Haemost. 2008;6(9):1550-6. doi:10.1111/j.1538-7836.2008.03059.x.

4. Granger CB, Alxander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-92. doi:10.1056/NEJMoa1107039.

5. Connolly SJ, Ezekowitz MD, Yusuf S, et al. RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-151. doi:10.1056/NEJMoa0905561.

6. Manesh RP, Mahaffey KW, Garg J, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med. 2011;365:883-91. doi:101056/NEJMoa1009638.

7. Zalesak M, Siu K, Francis K, et al. Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin. Circ Cardiovasc Qual Outcomes. 2013;6(5):567-74. doi:10.1161/CIRCOUTCOMES.113.000192.

8. Song X, Sander SD, Varker H, et al. Patterns and predictors of use of warfarin and other common long-term medications in patients with atrial fibrillation. Am J Cardiovasc Drugs. 2012;12(4):245-53. doi:10.2165/11632540-000000000-00000.

9. Laliberte F, Cloutier M, Nelson WW, et al. Real-world comparative effectiveness and safety of rivaroxaban and warfarin in nonvalvular atrial fibrillation patients. Curr Med Res Opin. 2014;30(7):1317-25. doi: 10.1185/03007995.2014.907140.

10. Shore S, Carey EP, Turakhia MP, et al Adherence to dabigatran therapy and longitudinal patient outcomes: insights from the Veterans Health Administration. Am Heart J. 2014;167(6):810-7. doi:10.1016/j.ahj.2014.03.023.

11. Martsevich SYu, Navasardyan AR, Kutishenko NP, et al. The assessment of compliance to the use of new oral anticoagulants in patients with atrial fibrillation according to the PROFILE register. Ration Pharmacother Cardiol. 2014;10(6):625-30. (In Russ.)

12. Borne RT, O'Donnell C, Turakhia MP, et al. Adherence and outcomes to direct oral anticoagulants among patients with atrial fibrillation: findings from the veterans health administration. BMC Cardiovasc Disord. 2017;17(1):236. doi:10.1186/s12872-017-0671-6.

13. Collings SL, Lefevre C, Johnson ME, et al. Oral anticoagulant persistence in patients with non-valvular atrial fibrillation: a cohort study using primary care data in Germany. PLoS One. 2017;12(10):e0185642. doi:10.1371/journal.pone.0185642

14. Skirdenko YuP, Shustov AV, Zherebilov VV, et al. Adherence to treatment in patients with atrial fibrillation. Mezhdunarodnyj zhurnal ehksperimental'nogo obrazovaniya. 2016;4(3):510. (In Russ.)

15. Nikolaev NA, Skirdenko YuP. Russian generic questionnaire for evaluation of compliance to drug therapy. Clin. Pharmacol. Ther. 2018;27(1):74-8. (In Russ.)


Review

For citations:


Skirdenko Yu.P., Nikolaev N.A. Contribution of anticoagulant therapy adherence to the risk of complications of atrial fibrillation. Russian Journal of Cardiology. 2019;(2):64-69. (In Russ.) https://doi.org/10.15829/1560-4071-2019-2-64-69

Views: 1138


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1560-4071 (Print)
ISSN 2618-7620 (Online)