Safety of once- or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study

Authors

  • Sadık Volkan Emren Department of Cardiology, Faculty of Medicine, Katip Celebi University, Izmir, Turkey
  • Mehdi Zoghi Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
  • Rida Berilgen Department of Cardiology, Egepol Hospital, Izmir, Turkey
  • İbrahim Halil Özdemir Department of Cardiology, Celal Bayar University, Manisa, Turkey
  • Oğuzhan Çelik Department of Cardiology, School of Medicine, Hitit University, Çorum, Turkey
  • Nurullah Çetin Department of Cardiology, Karşıyaka State Hospital, Izmir, Turkey
  • Asım Enhoş Department of Cardiology, Mustafa Kemal Paşa State Hospital, Bursa, Turkey
  • Cemal Köseoğlu Department of Cardiology, Ankara Research and Education Hospital, Ankara, Turkey
  • Abdurrahman Akyüz Department of Cardiology, Gazi Yaşargil Research and Education Hospital, Diyarbakır, Turkey
  • Volkan Doğan Department of Cardiology, School of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
  • Fatih Levent Department of Cardiology, Çivril State Hospital, Denizli, Turkey
  • Yüksel Dereli Department of Cardiovascular Surgery, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
  • Tolga Doğan Department of Cardiology, School of Medicine, Hitit University, Çorum, Turkey
  • Özcan Başaran Department of Cardiology, School of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
  • Ilgın Karaca Department of Cardiology, School of Medicine, Fırat University, Elazığ, Turkey
  • Özkan Karaca Department of Cardiology, School of Medicine, Fırat University, Elazığ, Turkey
  • Yılmaz Ömür Otlu Department of Cardiology, Egemed Hospital, Aydın, Turkey
  • Çağlar Özmen Department of Cardiology, Pazarcık State Hospital, Kahramanmaraş, Turkey
  • Selvi Coşar Department of Cardiology, Tunceli State Hospital, Tunceli, Turkey
  • Mutlu Sümerkan Department of Cardiology, Şişli Etfal Research and Education Hospital, Istanbul, Turkey
  • Erdal Gürsul Department of Cardiology, Biga State Hospital, Çanakkale, Turkey
  • Sinan İnci Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
  • Ersel Onrat Department of Cardiology, Afyon Kocatepe University, Afyonkarahisar, Turkey
  • Oktay Ergene Department of Cardiology, School of Medicine, Dokuz Eylül University, Izmir, Turkey

DOI:

https://doi.org/10.17305/bjbms.2017.2279

Keywords:

Daily dosing, bleeding, medication adherence, non-vitamin K antagonist oral anticoagulants, self-report, NOACs, nonvalvular atrial fibrillation, NVAF

Abstract

Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once- or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1:1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 ± 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23–2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3–20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04–5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.

Author Biographies

  • Sadık Volkan Emren, Department of Cardiology, Faculty of Medicine, Katip Celebi University, Izmir, Turkey
    Department of Cardiology
  • Mehdi Zoghi, Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
    Department of Cardiology
  • Rida Berilgen, Department of Cardiology, Egepol Hospital, Izmir, Turkey
    Department of Cardiology
  • İbrahim Halil Özdemir, Department of Cardiology, Celal Bayar University, Manisa, Turkey
    Department of Cardiology
  • Oğuzhan Çelik, Department of Cardiology, School of Medicine, Hitit University, Çorum, Turkey
    Department of Cardiology
  • Nurullah Çetin, Department of Cardiology, Karşıyaka State Hospital, Izmir, Turkey
    Department of Cardiology
  • Asım Enhoş, Department of Cardiology, Mustafa Kemal Paşa State Hospital, Bursa, Turkey
    Department of Cardiology
  • Cemal Köseoğlu, Department of Cardiology, Ankara Research and Education Hospital, Ankara, Turkey
    Department of Cardiology
  • Abdurrahman Akyüz, Department of Cardiology, Gazi Yaşargil Research and Education Hospital, Diyarbakır, Turkey
    Department of Cardiology
  • Volkan Doğan, Department of Cardiology, School of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
    Department of Cardiology
  • Fatih Levent, Department of Cardiology, Çivril State Hospital, Denizli, Turkey
    Department of Cardiology
  • Yüksel Dereli, Department of Cardiovascular Surgery, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
    Department of Cardiovascular Surgery
  • Tolga Doğan, Department of Cardiology, School of Medicine, Hitit University, Çorum, Turkey
    Department of Cardiology
  • Özcan Başaran, Department of Cardiology, School of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
    Department of Cardiology
  • Ilgın Karaca, Department of Cardiology, School of Medicine, Fırat University, Elazığ, Turkey
    Department of Cardiology
  • Özkan Karaca, Department of Cardiology, School of Medicine, Fırat University, Elazığ, Turkey
    Department of Cardiology
  • Yılmaz Ömür Otlu, Department of Cardiology, Egemed Hospital, Aydın, Turkey
    Department of Cardiology
  • Çağlar Özmen, Department of Cardiology, Pazarcık State Hospital, Kahramanmaraş, Turkey
    Department of Cardiology
  • Selvi Coşar, Department of Cardiology, Tunceli State Hospital, Tunceli, Turkey
    Department of Cardiology
  • Mutlu Sümerkan, Department of Cardiology, Şişli Etfal Research and Education Hospital, Istanbul, Turkey
    Department of Cardiology
  • Erdal Gürsul, Department of Cardiology, Biga State Hospital, Çanakkale, Turkey
    Department of Cardiology
  • Sinan İnci, Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
    Department of Cardiology
  • Ersel Onrat, Department of Cardiology, Afyon Kocatepe University, Afyonkarahisar, Turkey
    Department of Cardiology
  • Oktay Ergene, Department of Cardiology, School of Medicine, Dokuz Eylül University, Izmir, Turkey
    Department of Cardiology

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Safety of once- or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study

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Published

20-05-2018

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Translational and Clinical Research

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1.
Safety of once- or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study. Biomol Biomed [Internet]. 2018 May 20 [cited 2024 Mar. 29];18(2):185-90. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/2279