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First report on a comparative patient-oriented perspective on the use of non-vitamin-K oral anticoagulants or vitamin-K antagonists in atrial fibrillation: patients’ experiences, side-effects and practical problems leading to non-adherence.

Bennaghmouch, N., Veer, A.J.W.M. de, Zivelonghi, C., Dijk, L. van, Berg, J.M. ten. First report on a comparative patient-oriented perspective on the use of non-vitamin-K oral anticoagulants or vitamin-K antagonists in atrial fibrillation: patients’ experiences, side-effects and practical problems leading to non-adherence. Netherlands Heart Journal: 2019, 27(12), 596-604
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Background
Non-vitamin-K oral anticoagulants (NOACs) are recommended as the first-choice therapy
for stroke prevention in patients with non-valvular atrial fibrillation (AF). However, the lack ofmonitoring may impact patients’ adherence, and non-adherence to medication is a potential hazard to safe and efficacious use. This is the first report with a ‘comparative patient-oriented perspective’ regarding the use of anticoagulant medication in the NOACs era. Our aim was to compare patients’ self-reported practical problems, adverse events and non-adherence to
anticoagulation therapy.

Methods
A survey was conducted among patients with AF on either NOACs or vitamin-K antagonists (VKAs). The outcomes were self-reported non-adherence to anticoagulant medication, and patients’ experiences, adverse events and practical problems correlated with the intake of the drug itself.

Results
A total of 765 patients filled out the questionnaire, of which 389 (50.9%) were on VKAs and 376 (49.1%) on NOACs. Age (70.6± 8.8 vs 70.3± 9.1 years) and male gender (70.4% vs 64.6%) were similar in the two groups. A significantly higher proportion of VKA users than NOAC users reported having frequent (16.2% vs 3.7%, p> 0.001) or occasional (4.1%
vs 1.3%, p> 0.001) practical issues with medication intake. Self-reported non-adherence was significantly higher (24.4% vs 18.1%, p= 0.03) among VKA users. The incidence of self-reported adverse events was similar.

Conclusion
Patient experiences support the current guideline recommendations for NOACs as the firstchoice therapy: NOAC therapy resulted in a higher practical feasibility and better adherence when compared with VKA therapy, with a similar incidence of adverse events in both groups.