Adherence to dabigatran etexilate in atrial fibrillation patients intended to undergo electrical cardioversion

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  • Willemijn Comuth
  • Moniek P M de Maat, Department of hematology, Erasmus University Medical Center, Rotterdam
  • ,
  • Daan van de Kerkhof, Department of Clinical Biochemistry, Catharina hospital, Eindhoven, Netherlands
  • Jerzy Malczynski, Denmark
  • Steen Husted
  • ,
  • Steen Dalby Kristensen
  • Anna-Marie Bloch Münster, Syddansk Universitet

AIMS: Effective anticoagulation in patients undergoing electrical cardioversion (ECV) for symptomatic atrial fibrillation is important to prevent adverse events. High medication adherence is a requirement. In patients with newly diagnosed atrial fibrillation (n = 169) who were intended to undergo ECV, the aim of this study was to measure self-reported short- and long-term adherence, evaluate whether dabigatran plasma concentrations reflect adherence, measure treatment satisfaction and assess whether adherence and treatment satisfaction are correlated. METHODS AND RESULTS: Plasma concentrations (liquid-chromatography tandem mass spectrometry), the 8-point Morisky Medication Adherence Scale (MMAS-8) and the Anti-Clot Treatment Scale (ACTS) were measured after 3 weeks and 7 weeks of treatment. Combined mean peak (1-3 h after intake) and trough (10-16 h after intake) plasma concentrations were 175 (SD 109) ng/mL and 75 (SD 45) ng/mL, respectively. There was no relationship between short-term adherence (last 3 days) or long-term adherence (last 3-4 weeks) and plasma concentrations, unless the last intake was more than 48 h ago. After 7 weeks high, moderate, and low adherence, according to the MMAS-8, was seen in 74%, 21%, and 5% of patients, respectively. Treatment satisfaction was high (median ACTS score 68.5, range 46-75 points). Treatment satisfaction and adherence were not correlated. CONCLUSION: The percentage of patients in the high adherence group (74%) was lower than expected, which is a matter of concern. Dabigatran plasma concentrations could not detect short- or long-term non-adherence, unless the drug was last taken more than 48 h ago. Treatment satisfaction did not correlate with adherence.

Original languageEnglish
JournalEuropean heart journal. Cardiovascular pharmacotherapy
Pages (from-to)91-99
Number of pages9
Publication statusPublished - 2019

    Research areas

  • Antidepressive agents, Atrial fibrillation, Dabigatran, Drug interactions, Mass spectrometry, Medication adherence, Second generation

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