Conclusion
This study confirms that non-adherence in patients on DOACs is prevalent. Of the participants, 9% reported non-adherence on the MARS-5 (score <24). We found associations between non-adherence and both reported side effects and side effect burden. We also found that patients’ belief that DOACs have unpleasant side effects was associated with both non-adherence and more side-effects.
As previous research has already shown that the occurrence of side effects in patients on DOACs could also lead to non-persistence [8], we recommend that both physicians and pharmacists evaluate side effects with their DOAC patients on a regular base. If patients report side effects the possibility of adherence problems should be considered and taken care of as well. Both by assessing the side effect burden and by challenging and reframing concern beliefs, especially those about side effects. Monitoring long-term persistence in these patients is recommended as well. This study emphasizes the need for developing, testing and implementing practical tools to identify and coach non-adherent DOAC patients to optimize protection against thromboembolic complications.