Objectives

To describe how stroke survivors with atrial fibrillation implement direct oral anticoagulant treatment and propose appropriate metrics to describe adherence.

Materials and Methods

Stroke patients with atrial fibrillation electronically recorded their self-administered direct oral anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban) during a 6-month observation phase after hospitalisation for ischemic stroke. Taking and timing adherence, correct dosing days, drug holidays, time of the day and day of the week subsets, dose-to-dose intervals and longest intervals between two consecutive doses were calculated from electronic monitoring data to describe and discuss the implementation phase of adherence.

Results

Data from 41 patients were analysed. Median age was 77 (IQR = 69–84), 63.4% were male and the majority suffered a mild stroke (median NIHSS: 1). Mean taking and timing adherence exceeded 90%. Correct dosing occurred in 86.6% of the days. Seven patients (17.1%) had intake pauses of three or more consecutive days. Patients with twice-daily regimen (70.7%) had higher taking adherence in the morning than in the evening (94.4% versus 89.9%; p = 0.001). No therapy- or anamneses-related characteristic was associated with taking adherence.

Conclusions

Although adherence to direct oral anticoagulants of stroke patients with atrial fibrillation exceeded 90%, deviant intake patterns such as drug holidays and missed evening doses were common and raise concerns. Appropriate adherence metrics calculated from electronic monitoring data may guide healthcare professionals elucidating patient-tailored adherence-enhancing interventions.

ClinicalTrials.gov registration number: NCT03344146

中文翻译：

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对动态性房颤患者中风幸存者直接口服抗凝治疗的见解

目标

为了描述患有房颤的卒中幸存者如何实施直接口服抗凝治疗并提出适当的指标来描述依从性。

材料和方法

在缺血性卒中住院后的6个月观察期中，患有房颤的中风患者以电子方式记录了他们自行施用的直接口服抗凝剂（阿哌沙班，达比加群，依多沙班，利伐沙班）。从电子监测数据中计算出服药时间和依从性，正确的服药天数，禁药日，一天中的时间和一周中的一天中的子集，两次给药之间的剂量间隔和最长间隔，以描述和讨论药物的实施阶段。坚持。

结果

分析了来自41名患者的数据。中位年龄为77岁（IQR = 69-84），男性为63.4％，大多数患有轻度中风（NIHSS中位值为1）。平均服用量和时机坚持率超过90％。正确的剂量发生在86.6％的天。七名患者（17.1％）连续三天或更长时间出现摄入暂停。每天两次服药的患者（70.7％）在早上的依从性高于晚上（94.4％对89.9％；p  = 0.001）。坚持治疗没有与治疗或回忆相关的特征。

结论

尽管对患有房颤的中风患者直接口服抗凝药的依从性超过90％，但异常的摄入方式（如放假和错过夜间剂量）很常见，并引起了人们的关注。根据电子监控数据计算出的适当依从性指标可以指导医疗保健专业人员阐明患者量身定制的依从性增强干预措施。

ClinicalTrials.gov注册号：NCT03344146