Adherence and Safety in Patients to Non-vitamin K Antagonist Oral Anticoagulants for the Treatment of Atrial Fibrillation at Neurological Institute of Thailand
Keywords:
Adherence and safety, Atrial fibrillation, Non-vitamin K antagonist oral anticoagulantsAbstract
Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are effectively used in atrial fibrillation (AF). However, some studies have found that low adherence is associated with adverse outcomes and stroke events. Objective: To investigate problems related to adherence and safety among patients using NOACs. Method: This was a cross-sectional descriptive study involving 180 patients with AF taking NOACs at Neurological Institute of Thailand. Data were collected from October 1, 2022 to October 31, 2023. Adherence and safety were assessed using the Pharmaceutical Care Network Europe (PCNE) version 8.02 criteria. Result: Adverse drug reactions (ADRs) were the most common cause (20%) of drug-related problems (DRPs). Rivaroxaban and dabigatran were the most associated ADRs, accounting for 28.6% and 27.3%, respectively. Common ADRs included ecchymosis (13.9%), bleeding per gum (1.7%), hematuria (1.1%), and hematochezia (0.6%). Adherence was also identified as one of the problems (5.0%). Of these, it was mostly caused by either patients or caregivers who took less medication than prescribed or not taking it at all (47.4%). Bleeding events in non-adherence were found to be 1.1%. Using the PCNE system, the intervention for 34.6 of DRPs was the side effect reported to authorities. All identified problems were accepted and resolved at a rate of 88.9%. Conclusion: The study emphasizes the importance of addressing adherence and safety concerns in patients receiving NOACs. Using PCNE Classification to identify and manage DRPs could improve patient adherence, reduce ADRs. In addition, interventions by pharmacists to resolve DRPs are accepted and thereby enhancing treatment outcomes.
References
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021;42(5):373-498.
Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, et al. 2021 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace. 2021;23(10):1612-76.
Chen A, Stecker E, A Warden B. Direct oral anticoagulant use: a practical guide to common clinical challenges. J Am Heart Assoc 2020;9(13)1-18.
Viprey M, Jeannin R, Piriou V, Chevalier P, Michel C, Aulagner G, et al. Prevalence of drug-related problems associated with direct oral anticoagulants in hospitalized patients: a multicenter, cross-sectional study. J Clin Pharm Ther 2017;42(1):58-63.
Johnson SA, Yarbrough PM, Rose RS, Lanspa MJ. Prescribing patterns of target-specific oral anticoagulants: an academic hospital perspective. Blood Coagul Fibrinolysis 2015;26(7):767-71.
Bassam S, Mansour S, Ajrouche R, Kisserwan H, Hajj ME, Zein S, et al. Drug-related problems and factors involved in the imbalance of oral anticoagulants in Lebanese patients: a cross-sectional study 2022. Dr. Sulaiman Al Habib Medical Journal 2022;2(4):77-85.
Shehab A, Bhagavathula AS, Abebe TB, Abegaz TM, Elnour AA, Sabbour HM, et al. Patient adherence to Novel Oral Anticoagulants (NOACs) for the teatment of atrial fibrillation and occurrence of associated bleeding events: a systematic review and meta-analysis. Curr Vasc Pharmacol 2019;17(4):341-9.
Emren SV, Şenöz O, Bilgin M, Beton O, Aslan A, Taşkin U, et al. Drug adherence in patients with nonvalvular atrial fibrillation taking non-vitamin k antagonist oral anticoagulants in Turkey: NOAC-TR. Clin Appl Thromb Hemost 2018;24(3):525-31.
Maneephan P, Rookkapan K. Drug related problems in patients hospitalized to a community hospital within three border southern provinces and management of the problems by pharmacist. Thai J Pharm Prac 2018;10(2):552-62.
Pharmaceutical Care Network Europe Foundation. PCNE classification for drug related problems V 9.1. [Internet] 2022. [cited 2022 Mar 7];9.1:1-10. Available from: www.pcne.org/ upload/files/230_PCNE_classification_V9-01.pdf.
Jarernsiripornkul N, Polkote N. Retrospective study of adverse drug reactions from warfarin at Srinagarind hospoital, Khon Kaen Province. KKU Res J 2006;11(3):228-36.
Honnonprai T. Development of programs to promote knowledge and behavior for self-assessment to reduce problems related to drug use of insulindependent diabetes mellitus Saithong Watthana Hospital Area Kamphaeng Phet Province. Journal of Public Health Tak Provincial Health Office 2022;2(3):1-13.
Gianluigi S, Robert G, Giuseppe R, lohn M, Giulia M, Gerasimos F, et al. Efficacy and safety of novel oral anticoagulant in patients with at atrial fibrillation and heart failure a meta-analysis. JACC: Heart failure 2016;4(11):870-80.
Mitsuntisuk P, Nathisuwan S, Junpanichjaroen A, Wongcharoen W, Phrommintikul A, Wattanaruengchai P, et al. Real-world comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants vs. warfarin in a developing country. Clin Pharmacol Ther 2021;109(5):1282-92.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Department of Medical Services, Ministry of Public Health
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของกรมการแพทย์ กระทรวงสาธารณสุข
ข้อความและข้อคิดเห็นต่างๆ เป็นของผู้เขียนบทความ ไม่ใช่ความเห็นของกองบรรณาธิการหรือของวารสารกรมการแพทย์
