Survey Says . . . Patients Like NOACs Better Than Warfarin

LISBON, Portugal—For patients with nonvalvular A-fib, one of the major selling points for use of non-vitamin K antagonist oral anticoagulants (NOACs) over warfarin for stroke prophylaxis has been that it makes patients’ lives easier: now there are data to back that up.

Using validated questionnaires, researchers led by Robert Tieleman, MD, PhD (Martini Hospital, Groningen, the Netherlands), showed that patient ratings of convenience and satisfaction increased significantly within 1 month of switching from a vitamin K antagonist (VKA) to dabigatran (Pradaxa; Boehringer Ingelheim), with further improvements seen through 6 months.

“We know that NOACs are safer than vitamin K antagonists. And we know for the first time now, because actually this was not done before, that patients on this NOAC—and we expect all NOACs—like the medication better and they trust the medication better,” Tieleman told TCTMD during a poster session at the European Heart Rhythm Association Congress 2019 here.

And though it remains to established in future studies, that increased satisfaction on NOACs should result in better long-term adherence, he added.

“If you dislike your therapy, you’re more likely to stop. And if you stop your therapy, then you’re at risk to get a stroke,” Tieleman said. “So we hope that putting patients on drugs which they dislike less helps to keep them on the medication for a long time.”

The findings come from an analysis of the RE-SONANCE study, a Boehringer Ingelheim-funded effort conducted in seven European countries looking at patient perceptions of their anticoagulation therapy with either dabigatran or a VKA. In the current analysis, researchers focused on the 583 patients who switched from a VKA to dabigatran during the study. Once on dabigatran, most patients (55.9%) used the 110-mg twice daily dose, with the rest using the 150-mg twice daily dose.

Using the validated Perception of Anticoagulant Treatment Questionnaire (PACT-Q2), the investigators assessed convenience and satisfaction before the switch was made from a VKA to dabigatran and then 1 and 6 months after the change. The questionnaire included questions about issues like side effects, missed work, expectations of treatment, and perceptions of harm and benefit.

While still taking a VKA, patients’ rated their convenience as an average of 63.4 out of 100. That increased to 77.3 at 1 month and 79.2 at 6 months (P < 0.0001). Similarly, mean satisfaction scores increased from 53.8 at baseline to 67.7 and 70.0 at 1 and 6 months, respectively (P < 0.0001).

If you dislike your therapy, you’re more likely to stop. And if you stop your therapy, then you’re at risk to get a stroke. Robert Tieleman

“They liked [dabigatran] much better,” Tieleman said. “It might be partly because they have less side effects, and of course the biggest thing is they didn’t need to be checked anymore. Their INR did not need to be controlled anymore.”

He noted that despite the inconvenience of getting an international normalized ratio (INR) checked every 3 to 4 weeks, some patients liked the security of the knowing that their therapy was being monitored and there was some question about whether they would feel as secure without that.

Nevertheless, “these patients felt safe” after making the switch to dabigatran, Tieleman said. “They did have less side effects and it was easier to use.”

It’s important to show those benefits because the per-pill cost is higher with NOACs than with VKAs, he said, adding that that greater expense has led some insurance payors to argue that patients don’t mind being on warfarin even with the frequent visits to get their INRs checked.

“We showed them that it is a problem for patients, that they feel a lot better with these new drugs, and we think in the long run it also helps to go on with therapy,” Tieleman said.

He speculated that the increases in convenience and satisfaction seen in this study might be even greater with NOACs that are taken just once a day and that come in a smaller pill size than dabigatran. Dabigatran can also cause some stomach discomfort if it’s not taken with food, Tieleman said, adding that taking the medication with meals overcomes that issue.

Physicians need to take the time to discuss the advantages of NOACs with their patients, Tieleman advised. “It’s easier not to talk about it because then they’re out of the office earlier, but it’s better for them to talk about it.”