Abstract
Introduction and aim
Patient quality of life (QOL) while on long-term oral anticoagulant therapy has been receiving greater attention in recent years due to the increase in life expectancy brought about by advances in medical care. This study aimed to compare the QOL, treatment satisfaction, hospitalization and bleeding rate in patients on long-term warfarin versus direct oral anticoagulants (DOAC).
Methods
This was a cross-sectional study of patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) on long-term anticoagulant therapy attending the cardiology clinic and anticoagulation clinic of the University Malaya Medical Centre from July 1, 2016, to June 30, 2018. Patient QOL was assessed by using the Short Form 12 Health Survey (SF12), while treatment satisfaction was assessed by using the Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2).
Results
A total of 208 patients were recruited; 52.4% received warfarin and 47.6% received DOAC. There was no significant difference in QOL between warfarin and DOAC based on SF12 (physical QOL, P=0.083; mental QOL, P=0.665). Nevertheless, patients in the DOAC group were significantly more satisfied with their treatment compared to the warfarin group based on PACT-Q2 (P=0.004). The hospitalisation rate was significantly higher in the warfarin group than the DOAC group (15.6% versus 3.0%, P=0.002). Clinically relevant minor bleeds and severe bleeding events were non-significantly higher in the warfarin group than the DOAC group (66.7% versus 40.0%, P=0.069).
Conclusion
Compared to warfarin, treatment of NVAF and VTE with DOAC showed comparable QOL, higher treatment satisfaction, lesser hospitalization, and a non-significant trend toward fewer bleeding episodes.
Acknowledgments
We want to express our gratitude to all the patients who had participated in the study. This study was fully supported by the Research Acculturation Grant Scheme of the Ministry of Education, Malaysia (RAGS/1/2015/SKK02/UNIMAS/03/1 and FA052000-0708-0028).
Ethics approval and informed consent
The UMMC hospital’s ethics committee approved this study with reference of Medical Ethic Committee Identity Number (MECID); number 2016823-4147. Written informed consent was obtained from all the study patients.
Abbreviations
AF, atrial fibrillation; VTE, venous thromboembolism; INR, international normalized ratio; DOAC, direct oral anticoagulants; QOL, quality of life; UMMC, University Malaya Medical Centre; NVAF, non-valvular atrial fibrillation; TTR, time in therapeutic range; SF12v2, Short Form 12v2 Health Survey; PACT-Q2, Perception of Anticoagulation Treatment Questionnaire 2; PF, physical functioning; RP, role physical; BP, bodily pain; GH, general health perceptions; V, vitality; SF, social functioning; RE, role emotional; MH, mental health; PCS, physical component summary; MCS, mental component summary; EQ-5D, EuroQOL instrument; RELY, Randomized Evaluation of Long-term Anticoagulant Therapy; EQ-5D-3L, EuroQOL instrument 3 levels; SF36, Short Form-36; ACTS, Anti-Clot Treatment Scale; XALIA, XA inhibition with rivaroxaban for Long-term and initial anticoagulation in venous thromboembolism.
Author contributions
All the authors contributed substantially to this study, in the following ways: substantial contributions to conception and design, data acquisition, or data analysis and interpretation; drafting the article or critically revising it for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of the work are appropriately investigated and resolved.
Disclosure
The authors report no conflicts of interest in this work.