Patient Knowledge and Adherence to Oral Anticoagulation Therapy: Findings from an Observational Study in Italian...

To assess treatment adherence, knowledge of oral anticoagulant (OA) therapy, and quality of life in adult patients on chronic anticoagulation, and to evaluate whether a brief educational intervention improves understanding and self-management.

An observational study was conducted in patients receiving OAs at three thrombosis centers in Genoa, Italy. Adherence, knowledge, and quality of life were assessed using validated questionnaires: Tool for Adherence Behaviour Screening (TABS), Anticoagulation Knowledge Tool (AKT), and EuroQol-5D-5L. A clinical pharmacologist delivered a brief educational session on treatment risks, drug-food interactions, and management. Questionnaires were re-administered at follow-up. Data were analyzed using descriptive statistics and nonparametric tests (Mann-Whitney, Kruskal-Wallis).

A total of 124 patients were enrolled (58.9% women; mean age 69.6 years); 61% were on Vitamin K Antagonists, while the remaining patients were treated with Direct Oral Anticoagulants. Mean adherence and knowledge scores were 37.1/40 and 18.1/23, respectively. Knowledge was weakly but significantly correlated with adherence (rs=0.190, p=0.035). Women showed higher knowledge scores than men (p=0.0117). Adherence and knowledge differed across centers (p=0.0037 and p<0.0001), with better outcomes in more individualized settings. Patients were more familiar with lifestyle aspects than with scientific therapy details. Quality of life varied by gender (p=0.0351), education (p=0.0021), occupation (p=0.0156), age (p=0.012) and living alone (p=0.041). At follow-up, knowledge scores increased after the educational intervention (18.1 vs 21.7); however, only 25 patients completed the questionnaires again, limiting the reliability of these findings, which should therefore be considered exploratory.

A weak but significant association between knowledge and treatment adherence was observed in patients receiving oral anticoagulants. Patient education may be a useful tool to improve patients' understanding of the risk-benefit profile of anticoagulation treatment and thus treatment adherence. However, further studies are issued to confirm this study hypothesis-generating exploratory findings with a larger patient population and more objective measures of patient adherence.