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

Purpose: 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. Patients and Methods: 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). Results: 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. Conclusion: 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.