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Medication Adherence to Direct Oral Anticoagulants: Extent and Impact of Side Effects

Bas J W van de Steeg1, Anne C Esselink2, Hugo A J M de Wit1

  • 1Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.

Patient Preference and Adherence
|August 28, 2024
PubMed

Insights

Medication adherence for direct oral anticoagulants (DOACs) is crucial but not guaranteed. Side effects, like bruising and bleeds, significantly impact adherence, even when patients believe DOACs are necessary.

Area of Science:

  • Pharmacology
  • Patient Adherence
  • Thromboembolism Prevention

Background:

  • Arterial and venous thromboembolism are leading causes of mortality.
  • Direct oral anticoagulants (DOACs) are effective for stroke prevention and venous thrombotic events.
  • Medication adherence is essential for optimal protection against thromboembolic complications.

Purpose of the Study:

  • To investigate adherence among direct oral anticoagulant (DOAC) users.
  • To explore associations between beliefs about medication, perceived side effects, and adherence.
  • To assess the impact of side effects on DOAC adherence.

Main Methods:

  • A cross-sectional study of 100 adult DOAC users in Dutch community pharmacies.
  • Adherence assessed using the Medication Adherence Rating Scale-5 (MARS-5).
  • Beliefs about DOACs and side effects were evaluated using specific questionnaires.

Main Results:

  • 9% of participants reported non-adherence based on the primary MARS-5 cut-off.
  • Adherence was associated with perceived side effects and side effect burden.
  • Bruising and minor bleeds were the most common side effects reported (20% each).
  • Necessity beliefs outweighed concern beliefs for all patients.
  • No associations found between adherence and gender, indication, DOAC type, or dosage.

Conclusions:

  • Adherence to direct oral anticoagulants (DOACs) requires careful monitoring.
  • Perceived side effects negatively impact adherence, overriding strong necessity beliefs.
  • Physicians and pharmacists should regularly assess both adherence and side effects in DOAC patients.
Abstract

Keywords:
BMQ-SDOACsMARS-5beliefscompliance

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