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Editorial
Ensuring adherence to therapy with anticoagulation in patients with atrial fibrillation
  1. Jeroen M Hendriks,
  2. Celine Gallagher,
  3. Prashanthan Sanders
  1. Centre for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, Australia
  1. Correspondence to Dr Jeroen M Hendriks, Centre for Heart Rhythm Disorders, University of Adelaide, Level 5 Mc Ewin Building, Royal Adelaide Hospital, North Terrace, Adelaide 5000, Australia; jeroen.hendriks{at}adelaide.edu.au

https://doi.org/10.1136/heartjnl-2017-311305

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    Atrial fibrillation (AF) is a significant burden for healthcare systems due to increased morbidity and mortality rates. It is a major cause of ischaemic stroke, which is considered one of the most serious and disabling complications of AF. Stroke prevention with oral anticoagulation (OAC) by vitamin K antagonists (VKA) or non-vitamin K antagonists (NOAC) is therefore a significant component of AF management. Both VKAs and NOACs are effective for the prevention of stroke in AF; however, stringent adherence to the recommended treatment regimen is crucial, both from a prescriber’s and a patient’s perspective. Worldwide, stroke prevention in AF is suboptimal, with poor adherence to international guideline recommendations.1 Poor adherence is a major barrier to effective stroke prevention, reflected in inadequate time in therapeutic range (TTR) with VKA treatment. A proposed advantage of NOAC therapy is the lack of requirement for routine blood monitoring for therapeutic levels. However, this fact, along with a short plasma half-life of approximately 12 hours, means that adherence to therapy becomes even more crucial, and indeed non-persistence or discontinuation of OAC treatment can have devastating consequences.2

    In this issue of the Journal, Jackevicius et al 3 published their findings on early non-persistence (within 6 months after initiation) with dabigatran and rivaroxaban in patients with AF. A retrospective cohort study was performed using linked administrative data from hospital admissions in Ontario, Canada, over a time period of 16 years (1998–2014). This cohort comprised patients aged ≥65 years with a diagnosis of AF prior to NOAC prescription. Given that both dabigatran and rivaroxaban were available on formulary from 2012 in Canada, all patients were considered new users of …

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    Footnotes

    • Contributors JMH, CG and PS were all involved in drafting and critically revising the editorial.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.

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