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  • Insights Into Direct Oral A...
    Albert, Valerie; Polymeris, Alexandros A.; Dietrich, Fine; Engelter, Stefan T.; Hersberger, Kurt E.; Schaedelin, Sabine; Lyrer, Philippe A.; Arnet, Isabelle

    Journal of stroke and cerebrovascular diseases, February 2021, 2021-Feb, 2021-02-00, Letnik: 30, Številka: 2
    Journal Article

    •Taking adherence to direct oral anticoagulants over 6 months of stroke survivors exceeded 90%•Calculations from electronic monitoring data can adequately describe adherence in the implementation phase•Especially evening non-adherence and drug holidays were detected•Targeted interventions can be deduced from electronic monitoring adherence analysis To describe how stroke survivors with atrial fibrillation implement direct oral anticoagulant treatment and propose appropriate metrics to describe adherence. Stroke patients with atrial fibrillation electronically recorded their self-administered direct oral anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban) during a 6-month observation phase after hospitalisation for ischemic stroke. Taking and timing adherence, correct dosing days, drug holidays, time of the day and day of the week subsets, dose-to-dose intervals and longest intervals between two consecutive doses were calculated from electronic monitoring data to describe and discuss the implementation phase of adherence. Data from 41 patients were analysed. Median age was 77 (IQR = 69–84), 63.4% were male and the majority suffered a mild stroke (median NIHSS: 1). Mean taking and timing adherence exceeded 90%. Correct dosing occurred in 86.6% of the days. Seven patients (17.1%) had intake pauses of three or more consecutive days. Patients with twice-daily regimen (70.7%) had higher taking adherence in the morning than in the evening (94.4% versus 89.9%; p = 0.001). No therapy- or anamneses-related characteristic was associated with taking adherence. Although adherence to direct oral anticoagulants of stroke patients with atrial fibrillation exceeded 90%, deviant intake patterns such as drug holidays and missed evening doses were common and raise concerns. Appropriate adherence metrics calculated from electronic monitoring data may guide healthcare professionals elucidating patient-tailored adherence-enhancing interventions. ClinicalTrials.gov registration number: NCT03344146