title: Ensuring medication adherence with direct oral anticoagulant drugs: lessons from adherence with vitamin K antagonists (VKAs).
abstract: Medication adherence (taking drugs properly) is uncommon among patients on warfarin. Poor adherence to warfarin leads to an increase in adverse medical events, including stroke in atrial fibrillation (AF). Factors related to patients, physicians and the health system account for poor adherence. Direct oral anticoagulants (DOACs) are easier to use than warfarin, with fewer drug and food interactions and no need for routine blood monitoring. A proper use of DOACs may reduce the risk of stroke in AF. However, in clinical settings where no laboratory monitoring is needed, a poor medication adherence is common and may impact clinical outcomes. In the management of chronic disorders, careful knowledge of the individual patient's attitudes and behaviors is a pre-requisite for a successful doctor-patient communication. To increase patient's awareness of the risks and benefits of DOACs and, in turn, increase medication adherence, at each follow-up visit physicians should screen for priorities and motivational problems; check for the lack of understanding and/or knowledge; assess any health system or personal barriers to medication adherence; identify appropriate interventions and provide tailored support to patient needs. Dissemination of guidelines to the health care chain (prescribing physician, general practitioners, caregivers, nurses, pharmacists) further encourages medication adherence. However, the long-term effect of some of these strategies is unknown; one tool may not fit all patients, and the prescribing physician should consider individualization of these aids to ensure medication adherence and persistence (continuing to take drugs properly in long-term treatments) for DOACs in every day practice.
authors: Dipartimento di Farmacia, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Napoli, Italy.
authors: Alessandro
authors: A
authors: Di Minno
authors: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Via S. Pansini 5, 80131, Napoli, Italy.
authors: Gaia
authors: G
authors: Spadarella
authors: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Via S. Pansini 5, 80131, Napoli, Italy.
authors: Antonella
authors: A
authors: Tufano
authors: Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Largo Brambilla 3, 50134, Firenze, Italy.
authors: Domenico
authors: D
authors: Prisco
authors: Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Via S. Pansini 5, 80131, Napoli, Italy. Electronic address: diminno@unina.it.
authors: Giovanni
authors: G
authors: Di Minno
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D006801:Humans; D055118:Medication Adherence; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin
keywords: Communication/cooperation between patients and doctors; Direct oral anticoagulants; Every day practice; Ex vivo laboratory tests; Patient’s awareness; Persistence