Thromb Haemost 2017; 117(02): 209-218
DOI: 10.1160/TH16-10-0757
Review Article
Schattauer GmbH

Adherence to oral anticoagulant therapy in patients with atrial fibrillation

Focus on non-vitamin K antagonist oral anticoagulants
Valeria Raparelli*
1  Department of Experimental Medicine, Sapienza-University of Rome, Rome, Italy
,
Marco Proietti*
2  Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy
3  University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
,
Roberto Cangemi
2  Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy
,
Gregory Y. H. Lip
3  University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
4  Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
,
Deirdre A. Lane#
3  University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
,
Stefania Basili#
2  Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy
5  Research Center on Gender and Evaluation and Promotion of Quality in Medicine (CEQUAM), Sapienza-University of Rome, Rome, Italy
› Author Affiliations
Further Information

Publication History

Received:06 October 2016

Acceptance after fast-track review:07 October 2016

Publication Date:
13 November 2017 (online)

Summary

Oral anticoagulation is pivotal in the management of thromboembolic risk in non-valvular atrial fibrillation (NVAF) patients. Effective anticoagulation is important to avoid major adverse events and medication adherence is central to achieve good anticoagulation control. Non-vitamin K antagonist oral anticoagulants (NOACs) are as effective and safe as vitamin K antagonist (VKAs) in NVAF patients. Due to the absence of routine anticoagulation monitoring with NOACs treatment, concerns have been raised about patient’s adherence to NOACs and real-life data demonstrates variability in adherence and persistence. A multi-level approach, including patients’ preferences, factors determining physicians’ prescribing habits and healthcare system infrastructure and support, is warranted to improve initiation and adherence of anticoagulants. Adherence to NOACs is paramount to achieve a clinical benefit. Implementation of educational programs and easy-to-use tools to identify patients most likely to be non-adherent to NOACs, are central issues in improving the quality of NVAF anticoagulation management.

Note: The review process for this manuscript was fully handled by C. Weber, Editor in Chief.

* Both authors equally contributed to the paper as first authors.


# Joint senior authors.