title: Adherence to anticoagulant treatment with dabigatran in a real-world setting.
abstract: BACKGROUND
  In clinical trials, adherence to a prescribed regimen with dabigatran was enhanced by frequent follow-up visits and pill counts.
  
  
  OBJECTIVE
  To describe the experience of dabigatran treatment in clinical practice, focusing on adherence.
  
  
  METHODS
  In a cross-sectional cohort study, we interviewed 103 patients treated for at least 3 months with dabigatran and followed by our anticoagulant clinic. We obtained information on the number of capsules of dabigatran dispensed by the pharmacy of each patient covering the entire treatment period and calculated the adherence. In addition, information on the frequency of missed capsules, bleeding, thromboembolic events and other adverse events, specifically dyspepsia, was captured from the interviews and medical records.
  
  
  RESULTS
  The mean age was 75.5 (± 8.5) years, 46% were females, and the mean CHADS2 score was 2.5. Dispensation data were obtained for 99 patients and adherence was 99.7% (median; interquartile range 94.6%-100%) with 11 patients showing < 80% adherence. During their interview, 31 patients (30%) acknowledged that they sometimes had missed taking the medication, ranging from 'twice in 6 years' to 'every day'. One additional patient with adherence < 80% was identified. Twenty-one patients (20%) reported bleeding complications, two of which were major; one patient had an ischemic stroke and 34 (33%) reported some degree of dyspepsia. There were no significant differences in the results between RE-LY study-experienced and study-naïve patients.
  
  
  CONCLUSIONS
  In our clinical practice adherence to the twice-daily dabigatran regimen was generally good, although 12% of the patients had an inadequate adherence. Routine feedback from the pharmacies could inform the physician to improve the anticoagulant management.
authors.affiliation: Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, 237 Barton Street East, Hamilton, Ontario, Canada. schulms@mcmaster.ca
authors.forename: S
authors.initials: S
authors.lastname: Schulman
authors.forename: B
authors.initials: B
authors.lastname: Shortt
authors.forename: M
authors.initials: M
authors.lastname: Robinson
authors.forename: J W
authors.initials: JW
authors.lastname: Eikelboom
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002214:Capsules; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D000069604:Dabigatran; D004415:Dyspepsia / Q000139:chemically induced; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D010353:Patient Education as Topic; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D002214:Capsules; D015091:beta-Alanine; D000069604:Dabigatran
keywords: atrial fibrillation; bleeding; cohort study; dabigatran; patient adherence