How Good Is Adherence to Dabigatran?

David Green, MD, PhD reviewing Shore S et al. JAMA 2015 Apr 14.

Nearly a quarter of Veterans Health Administration patients had medication gaps of more than 30 days.

Dabigatran, a target-specific oral anticoagulant, is more acceptable to patients than warfarin because there are no requirements for laboratory monitoring. However, less frequent contact with patients might result in lower compliance with dosing instructions.

To evaluate medication adherence, investigators collected dabigatran prescription information on 4863 patients with nonvalvular atrial fibrillation at 67 Veterans Health Administration (VHA) sites. In addition, they interviewed 47 pharmacists at 41 sites to assess factors associated with improved adherence, such as meticulous patient selection, education, and follow-up.

Whereas 72% of patients were adherent (defined as ≥80% of prescribed days covered by prescription), 23% had a medication gap of more than 30 days. Factors associated with adherence were appropriate patient selection for dabigatran treatment (relative risk, 1.14; 95% confidence interval 1.05–1.25) and participation of a dedicated pharmacist (RR, 1.25; 95% CI, 1.11–1.41). Adherence was also improved by the use of more intensive services, with clinician collaboration, for nonadherent patients.

CITATION(S):

Shore S et al. Site-level variation in and practices associated with dabigatran adherence. JAMA 2015 Apr 14; 313:1443.