Original Contribution  |   January 2017
Assessment of Patient Adherence to Direct Oral Anticoagulant vs Warfarin Therapy
Author Notes
  • From the Department of Sleep Medicine at Mayo Clinic in Rochester, Minnesota (Dr Patel); the Division of Hematology and Medical Oncology (Dr Cherington), the Division of Cardiovascular Diseases (Ms Barr and Drs Mookadam and Shamoun), and the Division of Biomedical Statistics and Informatics (Dr McLemore and Mr Cha) at Mayo Clinic in Scottsdale, Arizona; the Department of Hematology and Oncology at Oregon Health and Sciences University in Portland (Dr Scherber); and the Department of Community Health Sciences at the University of California, Los Angeles Fielding School of Public Health (Dr Morisky). 
  • Financial Disclosures: Dr Morisky receives royalties for use of the Morisky Medication Adherence Scale-8 item. 
  • Support: This study was supported by the Mayo Clinic Department of Cardiology in Scottsdale, Arizona. 
  •  *Address correspondence to Fadi Shamoun, MD, Division of Cardiovascular Diseases, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259-5452. E-mail: shamoun.fadi@mayo.edu
     
Article Information
Hypertension/Kidney Disease / Neuromusculoskeletal Disorders / Preventive Medicine / Professional Issues / Pulmonary Disorders
Original Contribution   |   January 2017
Assessment of Patient Adherence to Direct Oral Anticoagulant vs Warfarin Therapy
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 7-15. doi:10.7556/jaoa.2017.002
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 7-15. doi:10.7556/jaoa.2017.002
Abstract

Context: Direct oral anticoagulants (DOACs) may be as effective as, and at times safer than, warfarin. Because DOACs do not require regular serum level monitoring, patients’ interaction with the health care system may be reduced. To the authors’ knowledge, although studies have evaluated warfarin adherence, few studies have evaluated the real-world adherence to DOACs.

Objective: To evaluate whether a difference exists between medication adherence of patients taking DOACs vs patients taking warfarin.

Methods: The electronic medical records of the Anticoagulation Clinic database at Mayo Clinic in Scottsdale, Arizona, were reviewed. Inclusion criteria were adults taking DOACs and a matching cohort taking warfarin between January 1, 2011, and December 30, 2013. The Morisky Medication Adherence Scale-8 item, a validated medication adherence tool, was used to evaluate adherence in both cohorts, and the qualitative covariates were analyzed using ordinal logistic regression.

Results: Of 324 surveys that were sent, 110 patients (34.0%) responded. Most patients took DOACs for atrial fibrillation, and few took DOACs for venous thromboembolism. Overall, 60 of 66 patients (90.9%) in the DOAC group and 42 of 44 patients (95.5%) in the warfarin group reported medium or high adherence. Difference in adherence scores between the 2 groups was not statistically significant (P=.8).

Conclusion: Similar adherence was noted between DOACs and warfarin regardless of the frequency of serum level monitoring.

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