Warfarin discontinuation rates are not consistently higher than alternatives like aspirin, though non-adherence is linked to younger age, male sex, lower stroke risk, and poor cognitive function.
What are the determinants of adherence and persistence on long-term warfarin therapy for atrial fibrillation and venous thromboembolism?
Warfarin has modest adverse effects on quality of life, and discontinuation rates are not consistently higher than alternatives, though several demographic and clinical risk factors for non-adherence exist.
Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of thromboembolism Patrick P Kneeland, Margaret C FangThe University of California, San Francisco Division of Hospital Medicine, San Francisco, CA, USAAbstract: Warfarin therapy reduces morbidity and mortality related to thromboembolism. Yet adherence to long-term warfarin therapy remains challenging due to the risks of anticoagulantassociated complications and the burden of monitoring. The aim of this paper is to review determinants of adherence and persistence on long-term anticoagulant therapy for atrial fibrillation and venous thromboembolism. We evaluate what the current literature reveals about the impact of warfarin on quality of life, examine warfarin trial data for patterns of adherence, and summarize known risk factors for warfarin discontinuation. Studies suggest only modest adverse effects of warfarin on quality of life, but highlight the variability of individual lifestyle experiences of patients on warfarin. Interestingly, clinical trials comparing anticoagulant adherence to alternatives (such as aspirin) show that discontinuation rates on warfarin are not consistently higher than in control arms. Observational studies link a number of risk factors to warfarin non-adherence including younger age, male sex, lower stroke risk, poor cognitive function, poverty, and higher educational attainment. In addition to differentiating the relative impact of warfarin-associated complications (such as bleeding) versus the lifestyle burdens of warfarin monitoring on adherence, future investigation should focus on optimizing patient education and enhancing models of physician–patient shared-decision making around anticoagulation.Keywords: anticoagulation, warfarin, adherence, persistence, thromboembolism
Margaret C. Fang (Mon,) conducted a review in Atrial fibrillation and venous thromboembolism. Warfarin vs. Alternatives (such as aspirin) was evaluated on Adherence and persistence. Warfarin discontinuation rates are not consistently higher than alternatives like aspirin, though non-adherence is linked to younger age, male sex, lower stroke risk, and poor cognitive function.
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