Exploration of adherence and patient experiences with DOACs one year after switching from vitamin-K antagonists- insights from the switching study

TY - JOUR

T1 - Exploration of adherence and patient experiences with DOACs one year after switching from vitamin-K antagonists- insights from the switching study

AU - Bartoli-Abdou, John

AU - Patel, Jignesh P.

AU - Crawshaw, Jacob

AU - Vadher, Bipin

AU - Brown, Alison

AU - Roberts, Lara N.

AU - Patel, Raj K.

AU - Arya, Roopen

AU - Auyeung, Vivian

PY - 2018/2

Y1 - 2018/2

N2 - Background Current UK and European guidelines recommend anticoagulated patients prescribed warfarin with time in therapeutic range (TTR) < 65% be considered for DOAC therapy. There has been considerable concern that adherence with DOACs may be poor compared with warfarin. Little is known about the patient experience of switching from warfarin to DOAC and how patients manage their DOAC long term. Aim To conduct focus groups exploring patient's previous experiences with warfarin, their current experience with DOACs, their adherence to DOACs and the long-term service provision they envisage. Methods Patients enrolled on the Switching Study who had been switched from warfarin to a DOAC > 1 year previously were invited to participate in focus groups. Two focus groups for atrial fibrillation (AF) and two for secondary prevention of venous thromboembolism (VTE) patients were held at anticoagulation clinics in South London, UK. Data was analysed using framework analysis to extract dominant themes. Results Five VTE patients and 15 AF patients attended the focus groups. Dominant themes that emerged were: indication specific anticoagulation prioritisation, warfarin as a necessary inconvenience, DOACs as the anticoagulant of choice, concerns regarding DOAC monitoring, high adherence to DOACs and desire for long-term access to specialist anticoagulation services. Discussion VTE patients prioritised anticoagulation over other therapies whereas AF patients did not. All participants reported high levels of adherence to DOACs. Patients derived confidence from long-term management in specialist anticoagulation clinics stating a preference to be managed in such a service.

AB - Background Current UK and European guidelines recommend anticoagulated patients prescribed warfarin with time in therapeutic range (TTR) < 65% be considered for DOAC therapy. There has been considerable concern that adherence with DOACs may be poor compared with warfarin. Little is known about the patient experience of switching from warfarin to DOAC and how patients manage their DOAC long term. Aim To conduct focus groups exploring patient's previous experiences with warfarin, their current experience with DOACs, their adherence to DOACs and the long-term service provision they envisage. Methods Patients enrolled on the Switching Study who had been switched from warfarin to a DOAC > 1 year previously were invited to participate in focus groups. Two focus groups for atrial fibrillation (AF) and two for secondary prevention of venous thromboembolism (VTE) patients were held at anticoagulation clinics in South London, UK. Data was analysed using framework analysis to extract dominant themes. Results Five VTE patients and 15 AF patients attended the focus groups. Dominant themes that emerged were: indication specific anticoagulation prioritisation, warfarin as a necessary inconvenience, DOACs as the anticoagulant of choice, concerns regarding DOAC monitoring, high adherence to DOACs and desire for long-term access to specialist anticoagulation services. Discussion VTE patients prioritised anticoagulation over other therapies whereas AF patients did not. All participants reported high levels of adherence to DOACs. Patients derived confidence from long-term management in specialist anticoagulation clinics stating a preference to be managed in such a service.

KW - Warfarin

KW - Vitamin- K antagonists

KW - Direct oral anticoagulant

KW - DOAC

KW - Adherence

KW - Patient care

KW - Atrial fibrillation

KW - Venous thromboembolism

KW - Quality of life

U2 - 10.1016/j.thromres.2017.12.021

DO - 10.1016/j.thromres.2017.12.021

M3 - Article

SN - 0049-3848

VL - 162

SP - 62

EP - 68

JO - Thrombosis Research

JF - Thrombosis Research

ER -