Patient adherence to rivaroxaban in deep vein thrombosis, a cohort study in Switzerland: quantitative results.

Détails

ID Serval
serval:BIB_5981370ECFEE
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Patient adherence to rivaroxaban in deep vein thrombosis, a cohort study in Switzerland: quantitative results.
Périodique
International journal of clinical pharmacy
Auteur⸱e⸱s
Dotta-Celio J., Alatri A. (co-premier), Locatelli I., Salvi M., Bugnon O., Schneider M.P., Mazzolai L.
ISSN
2210-7711 (Electronic)
Statut éditorial
Publié
Date de publication
12/2019
Peer-reviewed
Oui
Volume
41
Numéro
6
Pages
1625-1633
Langue
anglais
Notes
Publication types: Journal Article ; Observational Study
Publication Status: ppublish
Résumé
Background Direct oral anticoagulants (DOACs) have the advantage of being administered orally at a fixed dose without laboratory monitoring, in contrast to the frequent international normalized ratio measurements used to adjust for vitamin K antagonists dosing. Rivaroxaban, has a short half-life. The anticoagulation effect rapidly decreases if medication adherence is suboptimal. Objective The purpose of this quantitative study (called RIVA) is to longitudinally describe adherence to rivaroxaban (implementation and persistence) in patients with deep vein thrombosis (DVT). Setting The community pharmacy of the Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland in collaboration with the angiology division of the Lausanne University Hospital (CHUV). Methods This is an observational study. Patients received rivaroxaban for 3 or 6 months: 15 mg twice a day during the first 3 weeks and then 20 mg once a day until the end of the treatment. Adherence was measured using electronic monitoring. Implementation and adherence were modelled using a generalized estimating equation model. Persistence was represented using a Kaplan-Meier survival curve. Main outcome measure Medication adherence (implementation and persistence). Results Thirty-one consecutive patients were included (68% male, mean age: 47 years old). The collected adherence data consisted of 57 inter-visit phases, 2899 electronic monitoring openings and a median follow-up of 92 days (IQR: 87; 100). Implementation to rivaroxaban was initially high [96.3 (92.8; 98.1)] but decreased during the first 3 weeks, until it reached 89.3 (76.0; 95.6). After the switch from twice a day 15 mg to a once a day 20 mg regimen, implementation increased again and remained stable [95.4 (92.2; 97.3)] for 90 days. Four patients who experienced adverse events discontinued the treatment before the end of the study and were considered non-persistent (clinically appropriate discontinuation). Conclusion Adherence to rivaroxaban in deep vein trombosis is high in persistent patients. Discontinuation is related to rivaroxaban adverse effects/toxicity. Implementation should be reinforced during the twice a day-phase, and this first 3-week experience should help patients and healthcare professionals choose the best timing for the once a day phase.
Mots-clé
Administration, Oral, Adult, Cohort Studies, Dose-Response Relationship, Drug, Drug Administration Schedule, Factor Xa Inhibitors/administration & dosage, Factor Xa Inhibitors/adverse effects, Female, Humans, Longitudinal Studies, Male, Medication Adherence/statistics & numerical data, Middle Aged, Rivaroxaban/administration & dosage, Rivaroxaban/adverse effects, Switzerland, Venous Thrombosis/drug therapy, Anticoagulants, Electronic monitoring, Interprofessionality, Medication adherence, Rivaroxaban, Venous thrombosis
Pubmed
Web of science
Open Access
Oui
Création de la notice
06/12/2019 16:51
Dernière modification de la notice
04/06/2020 5:20
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