Adherence to anticoagulant treatment with dabigatran in a real-world setting

Abstract

BACKGROUND: In clinical trials the adherence to prescribed regimen with dabigatran was enhanced by frequent follow-up visits and pill counts. OBJECTIVES: To describe the experience of dabigatran treatment in clinical practice, focusing on adherence PATIENTS/METHODS: In a cross-sectional cohort study we interviewed 103 patients treated 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 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 mean CHADS2 score was 2.5. Dispensation data was obtained for 99 patients and adherence was 99.7% (median; interquartile range 94.6-100%) with 11 patients showing <80% adherence. On the 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, 2 of which were major; 1 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-naive patients. CONCLUSION: 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. This article is protected by copyright. All rights reserved.