Dabigatran vs. Warfarin: What and Why Do Patients Prefer?
The key to adherence to long-term anticoagulant therapy is primarily the satisfaction of patients with the set therapy. The RE-SONANCE study published in April 2021 compared patient satisfaction with anticoagulant treatment using the direct oral anticoagulant (DOAC) dabigatran versus vitamin K antagonists (VKAs). What were the findings?
Introduction
Dabigatran represents an effective alternative to vitamin K antagonists in the prevention of stroke in patients with atrial fibrillation (AF). DOACs have shown the same efficacy as VKAs in patients with AF indicated for anticoagulant therapy to reduce the risk of stroke, and with dabigatran 150 mg 2× daily, these risks are even lower.
Methodology and Course of the RE-SONANCE Study
RE-SONANCE was an observational, prospective international study aimed at assessing satisfaction and comfort of treatment in patients transitioning from VKAs to dabigatran or newly diagnosed patients with AF using dabigatran or VKAs. The study included 9472 AF patients from 12 countries (including the Czech Republic). A validated questionnaire PACT-Q (Perception of Anticoagulant Treatment Questionnaire) was used for evaluation. Patients were monitored for 6 months, with most participants concurrently medicated for other comorbidities. Most individuals using dabigatran were treated with a dose of 150 mg 2× daily.
Key Findings
Scores in the PACT-Q questionnaire improved in patients transitioning from VKAs to dabigatran due to greater comfort and satisfaction. Better results were also observed in newly diagnosed patients who were immediately put on dabigatran compared to those initially given VKAs. Specifically, Czech patients experienced a statistically significant average increase in comfort and treatment satisfaction scores, similar to participants in Poland, Hungary, Romania, and Russia. Dabigatran was preferred across all age groups surveyed.
One question in the PACT-Q questionnaire was: “How confident are you that your anticoagulant treatment will prevent blood clots?” It was found that therapy with dabigatran offered patients a greater sense of security against blood clots compared to VKAs.
Why Do Patients in Routine Clinical Practice Struggle with Warfarin Treatment?
For many years, VKAs were the only available anticoagulant therapy. However, from the perspective of patient adherence to treatment, they have numerous disadvantages leading to inadequate and less than optimal adherence to prescribed therapy. The main ones include:
- narrow therapeutic window
- need for regular dose monitoring
- multiple interactions with other medications and food
Conclusion
The indication of appropriate anticoagulant therapy is, of course, the result of considering many factors, including current reimbursement conditions. However, the fundamental goal is to ensure good patient adherence to treatment, as this is key to the success of any therapy. If we have the option to choose, we should always consider patient preferences, satisfaction, and comfort.
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Source:
Vinereanu D., Napalkov D., Bergler-Klein J. et al. Patient perceptions of anticoagulant treatment with dabigatran or a vitamin K antagonist for stroke prevention in atrial fibrillation according to region and age: an exploratory analysis from the RE-SONANCE study. J Thromb Thrombolysis 2021 Apr 30, doi: 10.1007/s11239-021-02450-2 [Epub ahead of print].
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