Impact on adherence and clinical outcomes of an anticoagulation stewardship program in users of direct oral anticoagulants.

IF 1.4 4区医学 Q2 Medicine

Revista De Investigacion Clinica-Clinical and Translational Investigation Pub Date : 2025-04-04 DOI:10.24875/RIC.25000008

Mayra A Arenas-Beltrán, Paula Ruiz-Talero, Karen Navarro-Pérez, Pilar Alarcón-Robles, Alice D Salamanca, Oscar M Muñoz-Velandia

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引用次数: 0

Abstract

Background: Anticoagulation stewardship in warfarin users reduces thromboembolic and bleeding events and improves adherence. Limited data exist on its impact on adherence among direct oral anticoagulants (DOACs) users.

Objective: To evaluate whether inpatient and outpatient follow-up in an anticoagulation stewardship program improves adherence and clinical outcomes in DOAC users compared to usual care.

Methods: Cohort study of patients initiating DOAC therapy at a university medical center. Participants were categorized into anticoagulation stewardship and usual care cohorts. Adherence was assessed at 30, 90, and 180 days. Univariate and multivariate logistic regression models were used to identify factors associated with lower adherence.

Results: 250 patients were included, with 81 receiving anticoagulation stewardship follow up. Adherence at 30 days was intermediate-high in over 90% of participants. The no-follow-up group showed a higher proportion of patients with low adherence (9.4% versus 2.4%, p = 0.003) and bleeding complications (4.1% versus 0%, p = 0.063). Anticoagulation stewardship exhibited a trend toward higher adherence (odds ratio [OR]: 3.51; 95% confidence interval [CI]: 0.74-16.47; p = 0.107). Factors associated with lower adherence included higher educational level (OR: 0.20; 95% CI: 0.05-0.75; p = 0.018), enrollment in a subsidized health system (OR: 0.08; 95% CI: 0.01-0.64; p = 0.018), and deep venous thrombosis as an indication for anticoagulation.

Conclusion: Anticoagulation stewardship programs may enhance adherence to DOAC therapy. Prospective studies are needed to confirm these findings.

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直接口服抗凝剂对抗凝管理项目依从性和临床结果的影响。

背景：华法林使用者的抗凝管理减少了血栓栓塞和出血事件，并提高了依从性。关于其对直接口服抗凝剂（DOACs）使用者依从性影响的数据有限。目的：评估与常规护理相比，住院和门诊随访的抗凝管理项目是否能改善DOAC使用者的依从性和临床结果。方法：对在某大学医学中心接受DOAC治疗的患者进行队列研究。参与者被分为抗凝管理组和常规护理组。在30、90和180天对依从性进行评估。单因素和多因素logistic回归模型用于确定与低依从性相关的因素。结果：纳入250例患者，其中81例接受抗凝管理随访。超过90%的参与者在30天的依从性为中高。无随访组出现低依从性（9.4%比2.4%,p = 0.003）和出血并发症（4.1%比0%，p = 0.063）的比例更高。抗凝管理表现出更高依从性的趋势(优势比[OR]: 3.51；95%置信区间[CI]: 0.74-16.47；P = 0.107)。与较低依从性相关的因素包括较高的教育水平(OR: 0.20；95% ci: 0.05-0.75；p = 0.018)，参加补贴医疗系统(OR: 0.08；95% ci: 0.01-0.64；P = 0.018)，深静脉血栓作为抗凝指征。结论：抗凝管理方案可提高DOAC治疗的依从性。需要前瞻性研究来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista De Investigacion Clinica-Clinical and Translational Investigation 医学-医学：内科

CiteScore

3.00

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： The Revista de Investigación Clínica – Clinical and Translational Investigation (RIC-C&TI), publishes original clinical and biomedical research of interest to physicians in internal medicine, surgery, and any of their specialties. The Revista de Investigación Clínica – Clinical and Translational Investigation is the official journal of the National Institutes of Health of Mexico, which comprises a group of Institutes and High Specialty Hospitals belonging to the Ministery of Health. The journal is published both on-line and in printed version, appears bimonthly and publishes peer-reviewed original research articles as well as brief and in-depth reviews. All articles published are open access and can be immediately and permanently free for everyone to read and download. The journal accepts clinical and molecular research articles, short reports and reviews. Types of manuscripts: – Brief Communications – Research Letters – Original Articles – Brief Reviews – In-depth Reviews – Perspectives – Letters to the Editor