Patients with atrial fibrillation (AFib) cite multiple reasons for nonadherence to direct-acting oral anticoagulant (DOAC) therapy, according to a study published online in the Journal of the American Geriatrics Society.
Derjung M. Tarn, MD, PhD, from the University of California at Los Angeles, and colleagues sought to understand the reasons patients with AF are nonadherent to apixaban, the most often-prescribed DOAC, through semistructured telephone interviews with 42 patients with documented nonadherence to apixaban.
The researchers found that 35 of 42 patients started apixaban but stopped, skipped, or decreased dosing, whereas the remaining seven patients never started apixaban. Six major themes related to nonadherence emerged, including cost (two-thirds), bleeding (either fear of or experience with), lack of AF symptoms, the belief it was safe to skip doses, confusion about measurable effects, and incomplete or discordant patient-physician communication. Additionally, some patients started taking alternative or natural treatments in place of apixaban.
“In conclusion, this study describes patient-reported reasons underlying nonadherence to the DOAC apixaban that include cost, concerns about bleeding, uncertainty about the need for anticoagulation, and beliefs that skipping doses is inconsequential,” the authors write. “Patients did not always tell their physicians about their nonadherence. This work identifies targets for interventions to increase adherence.”
Bristol-Myers Squibb and Pfizer funded the study; Pfizer manufactures apixaban.
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