COMMENTARY

Are Your Patients With AF Taking Their Anticoagulants?

Samuel Z. Goldhaber, MD

Disclosures

November 18, 2014

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This is Dr Sam Goldhaber from the Clot Blog at theheart.org on Medscape, speaking to you from the European Society of Cardiology meetings in Barcelona. Today I will speak about cardiovascular medication adherence (particularly the anticoagulants) to prevent stroke in patients with permanent atrial fibrillation who are at high risk for stroke.

Medication adherence, in general, is a big problem. Healthcare providers prescribe a lot of medication and we tend to assume that patients are going to rush out and fill the prescriptions and take the medication as prescribed. But some shocking data have emerged from the US Department of Defense.[1] Military hospitals and veterans hospitals dispense medication at no charge, and without copays, to qualifying individuals, who must present their prescriptions to the pharmacy to receive their medications.

This study looked at individuals who had been prescribed either warfarin or dabigatran for stroke prevention in atrial fibrillation, to see whether these patients filled their prescriptions on an ongoing basis at the hospital pharmacies with no more than a 30-day gap within a single-year period. They found that persistence of use of warfarin was only 25%. That means that 75% of individuals who are prescribed warfarin for stroke prevention in atrial fibrillation were not taking their medication as prescribed.

The figures are a bit better for dabigatran. Dabigatran prescriptions were filled 50% of the time, so the medication adherence (allowing up to 30 days of not taking dabigatran) during the calendar year was 50%.

These numbers are terrible and reflect poorly on our system of care. We have to do more in terms of education and motivation, and we need more collaboration with our patients in developing the treatment plan to get our patients to buy into the concept of anticoagulation if they are at high risk for stroke.

These findings also tell us that whenever we meet with our patients in the office on a one-to-one basis, we must reconcile the medications that they are actually taking with what is on their list of medications in the medical record. Usually there are some gaps. It is important that we spend the time and get on the same page with our patients and explain again—with patience, understanding, and compassion—why we are making our recommendations for drug treatment. Whether we are using a novel oral anticoagulant or warfarin, we can do more to improve adherence and compliance with anticoagulation agents to prevent stroke.

This is Dr Sam Goldhaber, signing off for the Clot Blog.

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