title: Adherence to oral anticoagulant therapy in secondary stroke prevention - impact of the novel oral anticoagulants.
abstract: BACKGROUND
  Oral anticoagulant therapy (OAT) potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA) have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC) have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention.
  
  
  METHODS
  All patients treated from October 2011 to September 2012 for ischemic stroke or transient ischemic attack with a subsequent indication for OAT, at three academic hospitals were entered into a prospective registry, and baseline data and antithrombotic treatment at discharge were recorded. At the 1-year follow-up, we assessed the adherence to different OAT strategies and patients' adherence to their respective OAT. We noted OAT changes, reasons to change treatment, and factors that influence persistence to the prescribed OAT.
  
  
  RESULTS
  In patients discharged on OAT, we achieved a fatality corrected response rate of 73.3% (n=209). A total of 92% of these patients received OAT at the 1-year follow-up. We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran. Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence.
  
  
  CONCLUSIONS
  One-year adherence to OAT after stroke is strong (>90%) and patients who switch therapy most commonly switch toward another OAT. The 1-year adherence rates to VKA and NOAC in secondary stroke prevention do not differ significantly between both therapeutic strategies.
authors.affiliation: Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Luger
authors.affiliation: Department of Neurology, Klinikum Fulda gAG, Fulda, Germany.
authors.forename: Carina
authors.initials: C
authors.lastname: Hohmann
authors.affiliation: Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Niemann
authors.affiliation: Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kraft
authors.affiliation: Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Ignaz
authors.initials: I
authors.lastname: Gunreben
authors.affiliation: Department of Neurology, Klinikum Fulda gAG, Fulda, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Neumann-Haefelin
authors.affiliation: Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kleinschnitz
authors.affiliation: Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Helmuth
authors.initials: H
authors.lastname: Steinmetz
authors.affiliation: Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Foerch
authors.affiliation: Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Waltraud
authors.initials: W
authors.lastname: Pfeilschifter
keywords: adherence; non-VKA oral anticoagulants; prevention; stroke; vitamin K antagonists