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Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants
  1. Andreas Capiau1,
  2. Els Mehuys1,
  3. Inge Van Tongelen1,
  4. Thierry Christiaens2,
  5. An De Sutter3,
  6. Stephane Steurbaut4,
  7. Souad Moudallel4,
  8. Silas Rydant5,
  9. Bernard Vrijens6,7,
  10. Tine L M de Backer8,9,
  11. Koen Boussery1
  1. 1 Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
  2. 2 Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
  3. 3 Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
  4. 4 Research Group Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
  5. 5 Royal Pharmacists Association of Antwerp, Antwerp, Belgium
  6. 6 Department of Public Health, University of Liege, Liege, Belgium
  7. 7 Research and Development, Aardex Group, Seraing, Belgium
  8. 8 Department of Cardiology, Heart Centre, University Hospital Ghent, Ghent, Belgium
  9. 9 Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
  1. Correspondence to Andreas Capiau, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium; Andreas.Capiau{at}


Objective This study aimed to assess implementation adherence (how well the patient’s actual intake matches the prescribed dosing regimen) to non-vitamin K antagonist oral anticoagulants (NOACs) and to explore experiences with and beliefs about NOACs in a real-world sample of long-term NOAC users.

Methods A cross-sectional observational study was conducted in home-dwelling adults who started taking a NOAC at least 1 year prior to inclusion. Pharmacy dispensing data were used to calculate the Medication Possession Ratio (MPR). Patients were recruited in 158 community pharmacies in Flanders, Belgium. They completed a questionnaire collecting basic characteristics and exploring self-reported adherence to NOACs (using the Medication Adherence Report Scale, MARS) and experiences with and beliefs about NOACs (using the Beliefs about Medicines Questionnaire, BMQ).

Results A total of 766 patients (mean age 76.2±8.8 years, median CHA2DS2-VASc score 4 (IQR=3–4)) were included. The majority (93.5%) used NOAC for stroke prevention in atrial fibrillation. The median MPR was 95.2% (IQR=87.8–99.7) which corresponds with half of the study population not taking their NOAC on at least 17 cumulative days per year. Almost 21% of participants reported non-adherence on the MARS (score <25), with unintentional non-adherence (forgetfulness) most frequently reported (15.4%). Although two-thirds of NOAC users indicated to experience adverse drug reactions, the BMQ demonstrated a positive attitude towards NOAC therapy, where necessity beliefs outweigh the concerns.

Conclusions Our data indicate that long-term NOAC users have high implementation adherence and a positive attitude towards NOAC therapy. However, taking into account patients’ thromboembolic risk and NOACs’ short half-lives, further optimisation of NOAC use seems warranted in this population.

  • atrial fibrillation
  • pharmacology

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  • Contributors EM, IVT, TC, ADS, SS, SR, TLdB and KB contributed to the study design. AC, EM and KB analysed the data. All authors contributed to data interpretation. AC wrote the first draft of the manuscript and all authors revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BV reports that he is the scientific lead at AARDEX Group.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Ethical Committee of Ghent University Hospital (B670201733429) and all participants provided written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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