Impact on Adherence and Clinical Outcomes of an Anticoagulation Stewardship Program in Users of Direct Oral Anticoagulants

Mayra A. Arenas-Beltrán, Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
Paula Ruiz-Talero, Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia; and Hospital Universitario San Ignacio, Bogotá, Colombia
Karen Navarro-Pérez, Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
Pilar Alarcón-Robles, Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
Alice Daniela Salamanca, Nursing Department, Hospital Universitario San Ignacio, Bogotá, Colombia
Oscar Muñoz, Department of Internal Medicine, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia; and Hospital Universitario San Ignacio, Bogotá, Colombia

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. (REV INVEST CLIN. [AHEAD OF PRINT])

Keywords: Anticoagulation stewardship. Drug adherence. Direct-acting oral anticoagulant. Atrial fibrillation. Venous thromboembolism.