Thromb Haemost 2021; 121(03): 366-382
DOI: 10.1055/s-0040-1716752
Stroke, Systemic or Venous Thromboembolism

Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis

1  Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
,
2  Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
3  Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
4  Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa (CAML), Lisboa, Portugal
,
Gonçalo Martins e Pereira
1  Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
,
Ricardo M. Fernandes
2  Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
3  Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
5  Serviço de Pediatria, Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte (CHLN), Centro Académico de Medicina de Lisboa, (CAML) Lisboa, Portugal
,
Joaquim J. Ferreira
2  Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
3  Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
6  CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
,
Fausto J. Pinto
7  Serviço de Cardiologia, Hospital de Santa Maria-CHLN, CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
,
João Costa
2  Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
3  Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
4  Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa (CAML), Lisboa, Portugal
,
2  Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
3  Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
7  Serviço de Cardiologia, Hospital de Santa Maria-CHLN, CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
› Author Affiliations
Funding None.

Abstract

Objective To undertake a systematic review and meta-analysis to assess the satisfaction of patients receiving nonvitamin K anticoagulants (NOACs), compared with vitamin K antagonists (VKAs).

Methods We searched CENTRAL, MEDLINE, Embase, and Clinicaltrials.gov for randomized controlled trials (RCTs) and observational studies. Two reviewers screened, extracted, and appraised data independently. We pooled data using a random-effects model. Outcome included treatment satisfaction, which was assessed by scores of Duke Anticoagulation Satisfaction Scale (DASS), Anticlot Treatment Scale (ACTS), Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), or Treatment Satisfaction Questionnaire for Medication version II (TSQM-VII) and their domains reported with 95% confidence intervals (95% CIs). We followed MOOSE and PRISMA guidelines.

Results We included four RCTs and 16 observational studies, enrolling 18,684 participants overall. Compared with VKAs, treatment with NOACs improved the ACTS Burdens score by 4.21 points (95% CI: 2.99–5.43, I 2 = 95%, combined n = 6,180), and ACTS Benefits by 0.49 points (95% CI: 0.18–0.81, I 2 = 85%, combined n = 6,171). Switching from VKAs to NOACs improved the ACTS Burdens score by 5.33 points (95% CI: 3.53–7.14, combined n = 3,097). Compared with VKAs, treatment with NOACs improved the TSQM-VII Global Satisfaction score by 6.86 points (95% CI: 3.00–10.73, combined n = 5,535).

Conclusion In patients with nonvalvular atrial fibrillation or venous thromboembolism, NOAC treatment is associated with greater satisfaction compared with VKAs. The switch from VKAs to NOACs was associated with improved patients' satisfaction. These effects were largely due to a lower degree of treatment burden with NOAC treatment.

Authors' Contributions

D.C., G.M.P., and V.K. conceived the idea for the protocol and made the main contribution to planning and preparation of timelines for its completion. V.K. and G.S.D. planned the data extraction and statistical analysis, as well as risk of bias, quality of evidence, and completeness of reporting assessments. V.K. designed the tables and wrote the first draft of the manuscript, which was then reviewed and amended by D.C., G.M.P., G.S.D., R.M.F., J.J.F., F.J.P., and J.C. All authors then approved the final written manuscript. D.C. is the guarantor for the work.


Supplementary Material



Publication History

Received: 04 June 2020

Accepted: 08 August 2020

Publication Date:
07 November 2020 (online)

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