<em>Factors affecting adherence to warfarin therapy anticipating the role of Novel Oral Anticoagulants (NOACs).</em> — The Association Specialists
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Factors affecting adherence to warfarin therapy anticipating the role of Novel Oral Anticoagulants (NOACs). (342)

Ekta Pandya 1 , Beata V Bajorek 1 2
  1. Graduate School of Health Pharmacy, University of Technology Sydney, Sydney, NSW, Australia
  2. Department of Pharmacy and Clinical Pharmacology, Royal North Shore Hospital, Sydney, NSW, Australia

Background

Patients’ adherence to warfarin therapy is integral to health outcomes, but can be difficult to maintain.  It is important to critically consider the potential of the Novel Oral Anticoagulants (NOACs: dabigatran, rivaroxaban, apixaban), to address the factors affecting patients adherence to anticoagulant therapy.

Objective

To qualitatively review patients’ perspectives towards warfarin therapy, identifying key factors known to affect adherence and acceptance of therapy, and subsequently how NOACs may address these.

Methods

A structured literature search: Phase 1: search via online databases and search platforms using key words. Phase 2: manual search of reference lists of selected papers to identify additional relevant publications focusing on exploring perspectives on anticoagulant / warfarin therapy and/or factors affecting decision-making, and studies assessing adherence to therapy.

Results:

Over 70 papers described factors associated with patients’ perspectives on, and adherence to, anticoagulant therapy. Although the issues are complex and multifactorial, the key factors decreasing willingness to take warfarin are: need for regular external blood testing, impact on daily living, drug interactions. Other factors affecting patients’ attitudes to a lesser extent are: drug-food interactions, fear of bleeding, challenges during travel, alcohol abstinence. Overall, patients were generally accepting of warfarin therapy, despite the challenges, and were willing to take it even when the risk benefit was less favourable. The NOACs, may potentially address the key factors affecting patients’ adherence, however, studies exploring patients’ willingness to change to NOACs indicate that some are unwilling due to established routines and fears around the lack of monitoring.

Conclusions:

NOACs are viable alternatives to warfarin, especially in those patients who are not adherent or accepting of warfarin due to the monitoring requirements and drug or food interactions. However, patient preferences must be factored into decision-making, and adherence assessed and supported during anticoagulant therapy, irrespective of the agent used.