Anticoagulants Clinical Trial
Official title:
Evaluating Medication Adherence to Novel Oral Anticoagulants With Anticoagulant Activity Monitoring in Patients With Atrial Fibrillation
The novel oral anticoagulants such as rivaroxaban, apixaban and dabigatran, specifically
target either thrombin or factor Xa/IIa. These new agents are included as an option for
prevention of thromboembolic disease or recurrent stroke in patients with non-valvular atrial
fibrillation in guidelines.
Although the benefits and risks of anticoagulation and antiplatelet therapy have been fully
assessed, and reasonable anticoagulation and antiplatelet therapies have been formulated, the
therapeutic effect still largely depends on the quality control during the treatment. Many
patients discontinue anticoagulant therapy after discharge or after a period of treatment,
and the risk of thrombosis increases. Because non-vitamin K antagonist oral anticoagulants
(NOACs) does not need routine monitoring, patients tend to ignore the regular medication,
thus affecting drug compliance. Because of the short half-life of NOACs, if patients do not
take it regularly, not only can not achieve the effectiveness of anticoagulation, but also
reduce the safety of medication. More and more researchers have realized that medication
adherence plays a key role in medical management. In order to improve the efficacy and safety
of NOACs and the compliance of patients with NOACs, the guidelines emphasize that
supplementary measures can be taken, such as pharmacists participating in the network
pharmacy database, attaching importance to the medication education of patients and their
families, formulating a strict follow-up plan and professional outpatient follow-up.
Patients with new oral anticoagulants will be included in the study. After the signing of the
informed consent, blood samples were collected to detect the anti Xa factor activity after
taking the drugs. Meanwhile, the medication compliance of the patients during the treatment
was also collected.
Dedicated tests based on anti-Xa activity for rivaroxaban and apixaban and anti-IIa activity
for dabigatran concentration was conducted. Blood samples are divided into peak concentration
and valley concentration. Peak concentration (Cmax) refers to the highest serum concentration
after administration for at least one week in the study. Valley concentration (Cmin), the
lowest concentration during administration, is usually obtained from the lowest concentration
between the initial time of administration and the next time the drug is administered at a
steady state (continuous medication for more than 1 weeks.).
A compliance questionnaire was conducted to collect the compliance of the drug during
treatment. The Morisky, Green, and Levine Adherence Scale (MGLS) was used to evaluate the
medication adherence of non-vitamin K antagonist oral anticoagulants (NOACs) patients.
Based on the results of data analysis, the correlation between anti Xa/IIa activity test
results and medication compliance was analyzed, making the anti Xa/IIa activity concentration
a simple measure to predict the compliance of patients.
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