Adherence to NOACs for secondary stroke prevention
What is it about?
Non-vitamin K antagonists (NOACs) have revolutionized long-term anticoagulation, which is most commonly indicated to prevent strokes in patients with atrial fibrillation. For any form of long-term anticoagulation, the therapeutic benefit of preventing disease and disability has to be balanced against an increased bleeding risk. Both the effectiveness as well as the safety of long-term anticoagulation heavily depends on the patient sticking to the prescribed medication scheme. Vitamin K antagonists (VKA), which were originally marketed as rodenticides have a long standing image problem with a lot of patients and doctors ("rat poison"). NOACs might be accepted more easily due to their superior safety in clinical trials and fixed dose regimes without cumbersome coagulation checks. On the other hand, NOACs might be regarded as "just another pill" and more easily abandoned once the patient feels that he is doing well. Read our publication to find out about the one-year adherence to oral anticoagulation of a cohort of stroke patients with an indication for anticoagulation in the years 2011/2012 when VKA and DOACs were approximately equally used ...
Why is it important?
Our findings show that the adherence to long-term anticoagulation is not significantly influenced by the choice of anticoagulant. We show a strong adherence to the general principle to anticoagulate after a cardioembolic stroke and most patients that switched treatment received an alternative anticoagulant. We presume that the broader choice of anticoagulants available nowadays enforces anticoagulation for stroke prevention.