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Patient Adherence to Novel Oral Anticoagulants (NOACs) for the Treatment of Atrial Fibrillation and Occurrence of Associated Bleeding Events: A Systematic Review and Meta-analysis

[ Vol. 17 , Issue. 4 ]

Author(s):

Abdulla Shehab*, Akshaya S. Bhagavathula, Tamrat B. Abebe, Tadesse M. Abegaz, Asim A. Elnour, Hani M. Sabbour, Masood Uzzafer, Ahmed Hersi and Adel K. Hamad   Pages 341 - 349 ( 9 )

Abstract:


Background: Real-world evidence from published observational studies of adherence to Novel Oral Anticoagulants (NOACs) medications and associated clinical outcome events in Atrial Fibrillation (AF) patients, was reviewed systematically.

Methods: Observational studies assessing patient adherence to NOACs conducted on AF patients between September 2010 and June 2016 were identified by systematic searching keywords to locate eligible studies, in accordance with Cochrane guidelines. PubMed, Scopus and Google Scholar databases were searched to identify the studies. Meta-analysis was performed using a random effects model with DerSimonian-Laird weighting to obtain pooled effect sizes.

Results: From 185 potentially relevant citations, 6 studies, comprising 1.6 million AF patients, were included. Among these, successful adherence to NOACs occurred in 75.6%. Adherence levels were higher in patients treated with dabigatran (72.7%) compared with those treated with apixaban (59.9%) or rivaroxaban (59.3%). However, adherence was still suboptimal (relative to an expected 80% adherence rate). Bleeding events in non-adherent patients were found to be 7.5%.

Conclusion: Suboptimal adherence to NOACs among AF patients was highlighted as a significant risk factor that may affect clinical outcomes, with a higher percentage of non-adherent patients having bleeding events. There is an urgent need for research on the effects of specific interventions to improve patient adherence to NOACs and to assess the related outcome factors that may be associated with adherence.

Keywords:

Adherence, novel oral anticoagulants (NOACs), stroke, atrial fibrillation, bleeding events, vitamin K, TTR.

Affiliation:

Department of Internal Medicine, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, Department of Clinical Pharmacy, University of Gondar, College of Medicine and Health Sciences, Gondar, Department of Clinical Pharmacy, University of Gondar, College of Medicine and Health Sciences, Gondar, Department of Clinical Pharmacy, University of Gondar, College of Medicine and Health Sciences, Gondar, Faculty of Pharmacy, Program Lead, Fatima College and Health Sciences (FCHS), Al Ain, Department of Cardiology, Brown University Warren Alpert School of Medicine, Rhode Island, Health Informatics Consultant, Dallas, Texas, Department of Cardiac Sciences, King Saud University, College of Medicine, Riyadh, Mohammed bin Khalifa Al Khalifa Cardiac Centre, Bahrain Defence Force Hospital, Ar-Rifaa

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