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Adherence to oral anticoagulation is poor in approximately half of atrial fibrillation patients who survive an ischemic stroke, and is associated with independent patient-related factors rather than composite risk scores. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

January 1, 2021Open Access

Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation

PTPaula TiiliElectrophysiology ILIoannis LeventisUniversity Hospital of Larissa JKJanne KinnunenUniversity of Helsinki

Structured PICO

What factors are associated with poor adherence to oral anticoagulation in atrial fibrillation patients who survived an ischemic stroke?

Population

396 patients with atrial fibrillation who survived an ischemic stroke, median age 75.0 years, 57% men, recruited from two prospective stroke registries in Larissa and Helsinki University Hospitals.

Intervention

Oral anticoagulation (non-vitamin K antagonist oral anticoagulants or vitamin-K antagonists)

Outcome

Adherence to oral anticoagulation assessed with the Adherence to Refills and Medications Scale (ARMS), with poor adherence defined as a score >17patient reported

Adherence to oral anticoagulation is poor in about half of AF patients surviving an ischemic stroke, driven by specific patient-related factors rather than composite risk scores.

Abstract

Background Non-vitamin K antagonist oral anticoagulants (NOAC) have superior safety and comparable efficacy profile compared to vitamin-K antagonists (VKAs), with more convenient dosing schemes. However, issues with adherence to the NOACs remain unsolved.Aims We sought to investigate the adherence to oral anticoagulation (OAC) and baseline factors associated with poor adherence after ischaemic stroke in patients with atrial fibrillation (AF).Methods We recruited hospitalised patients (2013–2019) from two prospective stroke registries in Larissa and Helsinki University Hospitals and invited survived patients to participate in a telephone interview. We assessed adherence with the Adherence to Refills and Medications Scale (ARMS) and defined poor adherence as a score of over 17. In addition to demographics, individual comorbidities, and stroke features, we assessed the association of CHA2DS2-VASc and SAMe-TT2R2 scores with poor adherence.Results Among 396 patients (median age 75.0 years, interquartile range IQR 70–80; 57% men; median time from ischaemic stroke to interview 21 months IQR 12–33; median ARMS score 17 IQR 17–19), 56% of warfarin users and 44% of NOAC users reported poor adherence. In the multivariable regression model adjusted for site, sex, and age, poor adherence was independently associated with tertiary education, absence of heart failure, smoking history, use of VKA prior to index stroke, and prior ischaemic stroke. CHA2DS2-VASc and SAMe-TT2R2 scores were not associated with poor adherence.Conclusions Adherence was poor in half of AF patients who survived an ischaemic stroke. Independent patient-related factors, rather than composite scores, were associated with poor adherence in these patients.KEY MESSAGESAdherence was poor in half of the atrial fibrillation patients who survived an ischaemic stroke.Independent patient-related factors rather than composite scores were associated with poor adherence.The findings support the importance of recognising adherence support as a crucial part of holistic patient care recommended by recent AF guideline.

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