Self-reported adherence to anticoagulation and its determinants using the Morisky medication adherence scale

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Lana A Castellucci1, Joseph Shaw1, Katrien van der Salm2

  • 1Department of Medicine at The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa,501 Smyth Road, Ottawa, Ontario,K1H 8L6, Canada.

Thrombosis Research
|August 15, 2015
PubMed

Insights

Self-reported anticoagulation adherence was similar for direct oral anticoagulants (DOACs) and vitamin-K antagonists (VKAs). Physicians should reinforce adherence importance, as predictors include age, female gender, and other medications.

Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Internal Medicine

Background:

  • Direct oral anticoagulants (DOACs) are crucial for venous thromboembolism (VTE) and atrial fibrillation (AF) stroke prevention.
  • Adequate adherence to DOACs is vital due to their shorter half-life and lack of routine laboratory monitoring compared to vitamin-K antagonists (VKAs).
  • Current clinical practice data on anticoagulation adherence remains unclear.

Purpose of the Study:

  • To evaluate self-reported anticoagulation adherence among patients treated at a tertiary anticoagulation clinic.
  • To compare adherence rates between DOACs and VKAs.
  • To identify factors associated with anticoagulation adherence.

Main Methods:

  • A cross-sectional study was conducted involving patients on oral anticoagulants (VKAs, rivaroxaban, dabigatran, apixaban).
  • The 4-item Morisky score was utilized to assess self-reported anticoagulation adherence.
  • Baseline patient characteristics were analyzed for their association with adherence levels.

Main Results:

  • The study included 500 patients: 74% on VKAs and 26% on DOACs (rivaroxaban, dabigatran, apixaban).
  • Primary indications were VTE (72%) and AF (18%).
  • Self-reported adherence was 56.2% for VKAs and 57.1% for DOACs. Significant predictors of adherence included older age, female gender, concurrent use of other oral medications, and retired employment status.

Conclusions:

  • Self-reported anticoagulation adherence rates were comparable between VKA and DOAC users.
  • Physicians should consistently emphasize the importance of anticoagulation adherence during patient interactions, especially pending universal DOAC laboratory assay availability.
  • The Morisky scale offers a straightforward method for assessing adherence, though its validation for this specific purpose requires further investigation.
Abstract

Keywords:
AnticoagulantMedication adherenceSelf-reportSurveyVenous thromboembolism

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