title: Patients satisfaction with warfarin and willingness to switch to dabigatran: a patient survey.
abstract: Warfarin is an anticoagulant medication that is challenging to manage. Dabigatran has been approved by the FDA for stroke and systemic embolism prevention in non-valvular atrial fibrillation as an alternative to warfarin. Dabigatran does not require routine monitoring, has an established dose, and lacks many of the drug, herbal, and food interactions that afflict warfarin. To evaluate patients' satisfaction with their current warfarin treatment and their opinion on switching to a newly marketed medication (dabigatran) through a brief survey. Two separate surveys were administered to (1) evaluate the patients' opinion of their warfarin therapy and (2) evaluate their thoughts on switching to a newer anticoagulant. Responses were recorded on a rating scale of 1-5; 1 being the least and 5 being the highest. Study was conducted at the Georgia Regents Health System (GRHS) pharmacy-based anticoagulation clinic. Two hundred sixty patients on warfarin treatment were enrolled. Patients expressed high satisfaction with warfarin treatment (4.7 ± 0.78). However, a vast majority of the patients were willing to switch to an agent that: requires less frequent follow-up visits (3.9 ± 1.35); lacks interaction with food and/or beverage (4.1 ± 1.25); is as efficacious as warfarin (3.7 ± 1.38). Patients expressed that out-of-pocket cost would be a major barrier to switch to this new medication (1.3 ± 0.58). Patients are satisfied with their warfarin treatment but willing to consider a new anticoagulant. Cost was highlighted as the most significant barrier. Efficacy, dietary freedom and less frequent visits are the major factors affecting the patients' decision.
authors.affiliation: Pharmacy Department, Georgia Regents Health System, 1120 15th Street, BI 2101, Augusta, GA, 30912, USA, hazemfelewa@gmail.com.
authors.forename: Hazem F
authors.initials: HF
authors.lastname: Elewa
authors.forename: Christina E
authors.initials: CE
authors.lastname: DeRemer
authors.forename: Kimble
authors.initials: K
authors.lastname: Keller
authors.forename: Jaspal
authors.initials: J
authors.lastname: Gujral
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Joshua
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D003365:Costs and Cost Analysis; D000069604:Dabigatran; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017060:Patient Satisfaction; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran
references.citation: J Thromb Thrombolysis. 2006 Aug;22(1):23-30
references.pmid: 16786229
references.citation: Ann Med. 2007;39(5):371-91
references.pmid: 17701479
references.citation: Patient Prefer Adherence. 2012;6:679-84
references.pmid: 23055701
references.citation: J Eval Clin Pract. 2013 Oct;19(5):938-43
references.pmid: 22834964
references.citation: Int J Cardiol. 2013 Oct 3;168(3):2540-7
references.pmid: 23664436
references.citation: Stroke. 1991 Aug;22(8):983-8
references.pmid: 1866765
references.citation: Circulation. 2011 Mar 15;123(10):1144-50
references.pmid: 21321155
references.citation: J Thromb Haemost. 2012 Sep;10(9):1841-8
references.pmid: 22812619
references.citation: N Engl J Med. 2009 Sep 17;361(12):1139-51
references.pmid: 19717844
references.citation: Arch Intern Med. 2012 Mar 12;172(5):397-402
references.pmid: 22231617
references.citation: Circulation. 2011 May 31;123(21):2363-72
references.pmid: 21576658
references.citation: Am J Ther. 2012 Nov;19(6):432-5
references.pmid: 22198071
references.citation: Lancet. 2010 Sep 18;376(9745):975-83
references.pmid: 20801496
references.citation: Heart Lung Circ. 2013 Jan;22(1):50-5
references.pmid: 23058974
references.citation: J Thromb Haemost. 2012 Dec;10(12):2621-4
references.pmid: 23006126
references.citation: Chest. 2012 Feb;141(2 Suppl):e531S-e575S
references.pmid: 22315271
references.citation: Ann Intern Med. 1999 Oct 5;131(7):492-501
references.pmid: 10507957