Novel Oral Anticoagulants

Tackling adherence challenges in the UK

Background

Novel oral anticoagulants are approved in the UK for:

  • Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation with one or more risk factors
  • Treatment and prevention of recurrent deep vein thrombosis and pulmonary embolism

They are also used short-term to prevent venous thromboembolism in adults undergoing elective hip or knee replacement surgery.

Inadequate compliance to oral anticoagulants – the risks

The need for effective treatment and prevention of thromboembolic events is clear:

Each year in England, approximately 110,000 people have a first or recurrent stroke. More than 900,000 people in England are living with the effects of stroke (NICE, 2008)
Stroke risk in patients diagnosed with atrial fibrillation increases from 1.5% in the fifth decade of life to 23.5% in patients aged more than 80 years, underlining the need for effective treatment.
As a result of inadequate compliance with anticoagulants, postoperative thromboembolism occurs in up to 10% of patients undergoing hip or knee replacement.
In England, stroke is estimated to cost the economy around £7 billion per year (NICE, 2008)

How Patient Connect helped

Patient Connect alerted its UK network of 6900 pharmacies to the adherence challenges, and initiated a patient support programme to help patients understand the importance of taking their oral anticoagulant medication properly.

At the point-of-dispensing the target anticoagulant, pharmacists verbalised the below clinical message to patients:'Your doctor has prescribed you this medicine because you are at increased risk of unwanted blood clots or a heart attack. You must take it regularly, every day, to help reduce these risks.'

Results

Dispensed volumes increased early on in the programme, and within six months the increase in dispensed volumes reached 5% growth, suggesting the programme has a significant positive impact on medication compliance.