Assessment of quality of life, satisfaction with anticoagulation therapy, and adherence to treatment in patients receiving long-course vitamin K antagonists or direct oral anticoagulants for venous thromboembolism

Ingre Keita, Isabelle Aubin-Auger, Christophe Lalanne, Jean-Pierre Aubert, Olivier Chassany, Martin Duracinsky, Isabelle Mahé, Ingre Keita, Isabelle Aubin-Auger, Christophe Lalanne, Jean-Pierre Aubert, Olivier Chassany, Martin Duracinsky, Isabelle Mahé

Abstract

Introduction: Direct oral anticoagulants (DOACs) have shown non-inferiority and ease of use compared to vitamin K antagonists (VKA) in the treatment of venous thromboembolism (VTE). No study so far has been directed toward real-life experience of outpatients receiving anticoagulants for VTE in France.

Methods: This is an observational descriptive real-life epidemiological study, using three validated questionnaires (Morisky Medication Adherence Scale-8, EQ-5D, and part 2 of the Perception of Anticoagulant Treatment Questionnaire), to assess adherence, quality of life, and satisfaction in 100 VTE outpatients receiving anticoagulation therapy by VKA (primary or switched from DOAC to VKA) or by DOAC (primary or switched from VKA to DOAC).

Results: Patients were very much satisfied with their treatment in both DOAC and VKA groups. Despite advantages of DOACs, therapeutic adherence was only moderate. The best adherence scores were observed in the primary VKA switched to DOAC for at least 3 months (S-DOAC) subgroup. Quality of life was better in the DOAC group mainly because of the absence of the requirement for blood testing. Most of the complaints concerned the pain/discomfort dimension in the VKA group and anxiety/depression dimension in the DOAC group.

Conclusion: Patients were satisfied with their anticoagulant treatment, especially when they were involved in choosing the anticoagulant, and the treatment suited them. Quality of life of patients in the DOAC group was better than in the VKA group, but adherence remains to be improved. This study highlights the importance of the physician-patient relationship, pretreatment initiation, and follow-up of any anticoagulation therapy throughout.

Keywords: deep venous thrombosis; medication adherence; oral anticoagulant; pulmonary embolism; quality of life; treatment satisfaction.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart. Abbreviations: DOAC, direct oral anticoagulant; VKA, vitamin K antagonist; P-VKA, primary VKA for at least 3 months, and no prior DOAC; P-DOAC, primary DOAC for at least 3 months, and no prior VKA; S-DOAC, primary VKA switched to DOAC for at least 3 months.
Figure 2
Figure 2
Quality of life scores (EQ-5D) in DOAC and VKA groups. Abbreviations: DOAC, direct oral anticoagulant; F, female; M, male; VKA, vitamin K antagonist.
Figure 3
Figure 3
Scores on EQ-5D visual analog scale (EQ-VAS). Abbreviations: DOAC, direct oral anticoagulant; VKA, vitamin K antagonist.
Figure 4
Figure 4
Scores on PACT-Q2 questionnaire. Abbreviations: DOAC, direct oral anticoagulant; F, female; M, male; VKA, vitamin K antagonist; PACT-Q2, part 2 of the Perception of Anticoagulant Treatment Questionnaire.

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