Trends in gebruik van directe orale anticoagulantia: een case-controlstudie

BACKGROUND: Anticoagulation non-adherence is attributed to myriad factors in patient populations across the world. While direct oral anticoagulants (DOACs) have demonstrated several clinical advantages over other anticoagulant classes, non-adherence persists and the underlying contributors vary by geography. OBJECTIVE: Outline patient and system level factors involved in DOAC non-adherence in the Bronx. METHODS: This retrospective review used all available electronic medical records on patients receiving active DOAC therapy from primary care centres in the Bronx between 2017-2024. Adherent and non-adherent groups were determined by prescription fill status and provider documentation. The two groups were compared by age, gender, race, ethnicity, insurance type, diagnostic indication for DOAC, pharmacy type, employment status, number of comorbidities, number of home medications and primary language. Univariable and multivariable logistic regressions were applied between the groups and categories. P values <0.05 were deemed significant. RESULTS: The cohort had 938 patients with non-adherence reported in 227 (24.2%) patients. In multivariable logistic regression, non-adherence was more common in younger patients (OR 1.19, CI 1.03 to 1.37, p=0.020) and in males (OR 1.41, CI 1.02 to 1.95, p=0.039). It was also more frequent among patients prescribing from hospital pharmacies (OR 2.70, CI 1.96 to 3.85, p=0.001) and the employed versus retired (OR 1.92, CI 1.09 to 3.57, p=0.032). Non-adherence was borderline significant in Black Non-Hispanics versus White Non-Hispanics (OR 1.75, CI 0.98 to 3.24, p=0.065) and in White Hispanics versus White Non-Hispanics (OR 1.98, CI 0.89 to 4.43, p=0.095). It was also borderline significant in English primary speakers versus Spanish primary speakers (OR 1.64, CI 0.96 to 2.86, p=0.071). CONCLUSION: DOAC non-adherence in the Bronx is significantly associated with patient age, gender, employment status and prescribing pharmacy type. Other factors investigated in this study had borderline significant or no significant association and warrant further investigation.