Comparing quality of life and treatment satisfaction between patients on warfarin and direct oral anticoagulants: a cross-sectional study

Figures & data

Table 1 Demographic characteristics of patients on oral anticoagulants

Characteristics		Anticoagulant type (n, %)		P-value
		Warfarin 109 (52.4)	DOACs 99 (47.6)
Age (mean ± SD)	Years	61.3±15.9	69.1±12.1	<0.001
Gender (n, %)	Male	55 (50.5)	52 (52.5)	0.766
	Female	54 (49.5)	47 (47.5)
Partner status (n, %)	No partner	35 (32.1)	35 (35.4)	0.621
	With partner	74 (67.9)	64 (64.6)
Ethnicity (n, %)	Malay	39 (35.8)	37 (37.4)	0.078
	Chinese	63 (57.8)	45 (45.5)
	Indian	5 (4.6)	13 (13.1)
	Others	2 (1.8)	4 (4.0)
Education (n, %)	None	6 (5.5)	7 (7.1)	0.395
	Primary	27 (24.8)	19 (19.2)
	Secondary	54 (49.5)	44 (44.4)
	College/tertiary	22 (20.2)	29 (29.3)
Occupation (n, %)	Unemployed	57 (52.3)	44 (44.4)	<0.001
	Government dependent/pensioner	22 (20.2)	44 (44.4)
	Private	30 (33.2)	11 (11.1)
Diet (n, %)	Non-vegetarian/vegan	105 (96.3)	92 (92.9)	0.274
	Vegetarian/vegan	4 (3.7)	7 (7.1)
Alcohol (n, %)	No	103 (94.5)	98 (99.0)	0.073
	Yes	6 (3.8)	1 (1.0)
Comorbidities (n, %)	≤2	69 (63.3)	53 (53.5)	0.153
	>2	40 (36.7)	46 (46.5)
Other drugs (n, %)	None	11 (10.1)	1 (1.0)	0.003
	<5	63 (57.8)	49 (49.5)
	≥5	35 (32.1)	49 (49.5)
Indication for anticoagulation (n, %)	NVAF	74 (67.9)	88 (88.9)	<0.001
	VTE	35 (32.1)	11 (11.1)
Duration of therapy (mean ± SD)	Years	8.5±7.0	3.2±2.0	<0.001
TTR (mean ± SD)	%	54.9±24.8	–	–
Good TTR (n, %)	Yes	49 (45.0)	–	–
	No	60 (55.0)	–
	Reasons:
	– Above therapeutic range	3 (5.0)
	– Above and below therapeutic range	46 (76.7)
	– Below therapeutic range	11 (18.3)

Abbreviations: DOACs, direct oral anticoagulants; NVAF, non-valvular atrial fibrillation; VTE, venous thromboembolism; TTR, time in therapeutic range.

Table 2 Comparison of QOL score between anticoagulant groups

SF12 v2 parameters	Without adjustment, mean ± SD; 95% CI			Adjusted for age,^a mean ± SD; 95% CI			Adjusted for duration,^a mean ± SD; 95% CI
	Warfarin	DOACs	P-value	Warfarin	DOACs	P-value	Warfarin	DOACs	P-value
PCS	45.0±10.2; 43.1–46.9	42.7±9.7; 40.8–44.6	0.095	44.3±0.9; 42.5–46.2	43.4±1.0; 41.5–45.4	0.502	45.1±1.0; 43.1–47.1	42.6±1.1; 40.5–44.7	0.105
MCS	52.7±8.5; 51.1–54.3	52.3±8.1; 50.7–53.9	0.731	53.0±0.8; 51.4–54.6	51.9±0.8; 50.3–53.6	0.365	52.5±0.8; 50.8–54.2	52.5±0.9; 50.8–54.2	0.982
PF	44.6±11.6; 42.4–46.8	43.0±11.0; 40.8–45.2	0.316	43.9±1.1; 41.7–46.0	43.8±1.1; 41.6–46.0	0.963	44.5±1.2; 42.3–46.8	43.0±1.1; 40.6–45.4	0.397
RP	46.7±10.5; 44.7–48.7	44.9±10.3; 42.8–46.9	0.209	46.3±1.0; 44.3–48.3	45.3±1.1; 43.3–47.4	0.518	46.6±1.1; 44.5–48.7	45.0±1.1; 42.8–47.1	0.318
BP	48.3±9.5; 46.5–50.1	47.2±11.2; 44.9–49.4	0.432	48.2±1.0; 46.2–50.2	47.2±1.1; 45.1–49.3	0.500	48.7±1.1; 46.6–50.8	46.7±1.1; 44.5–49.8	0.220
GH	46.1±10.5; 44.1–48.1	43.7±9.0; 41.9–45.5	0.076	45.8±1.0; 44.0–47.8	44.0±1.0; 42.0–46.0	0.200	45.9±1.0; 43.9–47.8	44.0±1.1; 41.9–46.0	0.222
V	53.3±11.1; 51.2–55.4	50.5±10.0; 48.5–52.5	0.055	53.1±1.0; 51.0–55.1	50.7±1.1; 48.6–52.9	0.122	53.7±1.1; 51.5–55.8	50.1±1.1; 47.8–52.3	0.032
SF	49.1±9.2; 47.4–50.9	47.6±10.8; 45.5–49.8	0.280	48.8±1.0; 46.9–50.7	48.1±1.0; 46.1–50.1	0.621	48.9±1.0; 46.9–50.9	47.9±1.1; 45.8–50.1	0.551
RE	47.6±10.7; 45.6–49.7	47.7±10.5; 45.6–49.8	0.960	47.7±1.0; 45.7–49.7	47.7±1.1; 45.5–49.8	0.979	47.3±1.1; 45.2–49.5	48.1±1.1; 45.8–50.3	0.656
MH	52.6±8.1; 51.1–54.2	52.4±8.3; 50.8–54.1	0.872	53.1±0.8; 51.6–54.6	51.9±0.8; 50.3–53.5	0.308	52.6±0.8; 50.9–54.2	52.5±0.9; 50.8–54.3	0.968

Note: ^aAdjusted with ANCOVA test.

Abbreviations: QOL, quality of life; DOACs, direct oral anticoagulants; SF12v2, Short Form 12v2 Health Survey; PCS, physical component summary; MCS, mental component summary; PF, physical functioning; RP, role physical; BP, bodily pain; GH, general health perceptions; V, vitality; SF, social functioning; RE, role emotional; MH, mental health.

Table 3 Comparison of convenience and satisfaction score between anticoagulant groups

PACT–Q2 parameters	Without adjustment, mean ± SD; 95% CI			With age adjustment,^a mean ± SD; 95% CI			With duration adjustment,^a mean ± SD; 95% CI
	Warfarin	DOAC	P-value	Warfarin	DOAC	P-value	Warfarin	DOAC	P-value
Convenience score	79.8±16.9;76.6–83.0	82.7±16.7; 79.3–86.0	0.229	80.7±1.6;77.5–83.9	81.7±1.7;78.4–85.1	0.658	80.1±1.7;76.8–83.5	82.3±1.8;78.8–85.9	0.410
Convenience item score:
B1. Difficulties in taking the treatment	4.6±0.8; 4.4–4.7	4.5±1.0; 4.3–4.7	0.670	4.6±0.1; 4.4–4.9	4.5±0.1; 4.3–4.6	0.243	4.6±0.1; 4.4–4.7	4.5±0.1; 4.3–4.7	0.806
B2. Bother in taking the treatment	4.5±0.8; 4.3–4.7	4.4±1.1; 4.2–4.6	0.455	4.6±0.1; 4.4–4.7	4.3±0.1; 4.2–4.5	0.106	4.5±0.1; 4.3–4.7	4.4±0.1; 4.2–4.6	0.595
B3. Difficulties regarding dose adjustment if needed	4.2±1.1; 4.0–4.4	4.5±1.0; 4.3–4.7	0.081	4.3±0.1; 4.1–4.5	4.4±0.1; 4.2–4.6	0.335	4.2±0.1; 4.0–4.4	4.4±0.1; 4.2–4.6	0.206
B4. Difficulties with other medication during treatment	4.4±1.0; 4.2–4.6	4.4±1.0; 4.2–4.6	0.899	4.4±0.1; 4.2–4.6	4.3±0.1; 4.1–4.5	0.439	4.4±0.1; 4.2–4.6	4.4±0.1; 4.2–4.6	0.979
B5. Difficulties in avoidance of certain food/difficult to take tablet during meals^#	3.9±1.2; 3.6–4.1	4.5±0.9; 4.3–4.7	<0.001	3.9±0.1; 3.7–4.1	4.5±0.1; 4.3–4.7	0.001	3.9±0.1; 3.7–4.1	4.5±0.1; 4.3–4.8	<0.001
B6. Difficulties taking treatment while being away from home	4.5±0.9; 4.3–4.6	4.6±0.7; 4.5–4.8	0.120	4.5±0.1; 4.3–4.6	4.6±0.1; 4.5–4.8	0.265	4.5±0.1; 4.3–4.7	4.6±0.1; 4.4–4.8	0.308
B7. Difficulties regarding daily life	4.0±1.1; 3.8–4.2	4.3±1.0; 4.1–4.5	0.047	4.0±0.1; 3.8–4.2	4.2±0.1; 4.0–4.5	0.110	4.0±0.1; 3.8–4.2	4.3±0.1; 4.0–4.5	0.100
B8. Bother in follow–up required	3.9±1.2; 3.7–4.1	4.2±1.0; 4.0–4.2	0.052	4.0±0.1; 3.7–4.2	4.2±0.1; 4.0–4.4	0.163	4.0±0.1; 3.7–4.2	4.2±0.1; 3.9–4.4	0.183
B9. Difficulties in regular intake	4.4±0.9; 4.2–4.5	4.6±0.8; 4.4–4.7	0.073	4.4±0.1; 4.3–4.6	4.5±0.1; 4.3–4.7	0.476	4.4±0.1; 4.2–4.5	4.6±0.1; 4.4–4.8	0.120
B10. Feeling loss of independency	4.4±1.1; 4.2–4.6	4.0±1.3; 3.8–4.3	0.049	4.3±0.1; 4.1–4.6	4.1±0.1; 3.8–4.3	0.127	4.3±0.1; 4.1–4.6	4.1±0.1; 3.8–4.3	0.168
B11. Worried about having to interrupt or stop treatment	3.3±1.3; 3.1–3.6	3.2±1.4; 3 2.9–3.4	0.400	3.3±0.1; 3.1–3.6	3.2±0.1; 2.9–3.4	0.326	3.4±0.1; 3.1–3.6	3.1±0.1; 2.9–3.4	0.315
C1. Impact of side effects on usual activities	4.2±1.0; 4.0–4.4	4.3±1.1; 4.1–4.5	0.630	4.2±0.1; 4.0–4.4	4.2±0.1; 4.0–4.4	0.930	4.3±0.1; 4.1–4.5	4.2±0.1; 4.0–4.4	0.625
C2. Discomfort due to symptoms	4.4±0.9; 4.2–4.5	4.5±1.0; 4.3–4.7	0.323	4.4±0.1; 4.2–4.6	4.5±0.1; 4.3–4.7	0.431	4.4±0.1; 4.2–4.6	4.5±0.1; 4.3–4.7	0.520
Anticoagulant treatment satisfaction score	68.7±11.3; 76.6–83.0	73.5±12.8;70.9–76.0	0.004	68.5±1.2;66.2–70.8	73.7±1.2;71.2–76.1	0.004	69.0±1.2;66.5–71.4	73.2±1.3;70.6–75.7	0.026
Satisfaction item score
D1. Feeling of reassurance	3.8±1.1; 3.6–4.0	4.0±1.0; 3.8–4.2	0.150	3.7±0.1; 3.5–3.9	4.0±0.1; 3.8–4.2	0.124	3.7±0.1; 3.5–3.9	4.0±0.1; 3.8–4.2	0.112
D2. Symptom decrease	3.2±1.2; 2.9–3.4	3.2±1.3; 3.0–3.5	0.706	3.1±0.1; 2.9–3.4	3.3±0.1; 3.0–3.5	0.495	3.2±0.1; 3.0–3.5	3.2±0.1; 2.9–3.4	0.828
D3. Experience with side effects	3.4±0.8; 3.3–3.6	4.1±1.1; 3.8–4.3	<0.001	3.5±0.1; 3.3–3.7	4.0±0.1; 3.8–4.2	<0.001	3.5±0.1; 3.3–3.7	4.0±0.1; 3.8–4.2	0.001
D4. Satisfaction regarding independency	3.8±0.8; 3.6–3.9	3.9±0.9; 3.7–4.1	0.312	3.8±0.1; 3.6–3.9	3.9±0.1; 3.8–4.1	0.126	3.8±0.1; 3.6–4.0	3.9±0.1; 3.7–4.1	0.397
D5. Satisfaction with patient management	3.9±0.7; 3.8–4.1	4.0±0.7; 3.9–4.1	0.633	3.9±0.1; 3.8–4.1	4.0±0.1; 3.9–4.1	0.602	3.9±0.1; 3.8–4.1	4.0±0.1; 3.8–4.1	0.690
D6. Satisfaction with treatment form	4.1±0.5; 4.0–4.1	4.3±0.7; 4.2–4.4	0.022	4.1±0.1; 4.0–4.2	4.3±0.1; 4.1–4.4	0.067	4.1±0.1; 4.0–4.2	4.3±0.1; 4.2–4.4	0.052
D7. Overall satisfaction	4.0±0.5; 3.9–4.1	4.2±0.6; 4.0–4.3	0.051	4.0±0.1; 3.9–4.1	4.2±0.1; 4.1–4.3	0.041	4.0±0.1; 3.9–4.1	4.2±0.1; 4.0–4.3	0.120

Notes: ^aAdjusted with ANCOVA test. The items in domain B and C were expressed as 6 minus item score. The PACT-Q questionnaire was modified for the DOAC group. ^#Item B5 for DOAC group was amended to “Is it difficult for you to take your tablet during meals, as recommended?” (this was not validated). Parameters used with permission and adapted from Prins MH, Marrel A, Carita P, et al. Multinational development of a questionnaire assessing patient satisfaction with anticoagulant treatment: the ‘Perception of Anticoagulant Treatment Questionnaire’ (PACT-Q). Health Qual Life Outcomes. 2009;7:9.¹⁷ PACT-Q © 2007 Sanofi-Aventis, France. All rights reserved.

Abbreviations: DOACs, direct oral anticoagulants; PACT-Q2, Perception of Anticoagulation Treatment Questionnaire 2.

Table 4 Hospitalization, bleeding and systemic embolism between anticoagulant groups

Characteristics		Anticoagulant type (n, %)		P-value
		Warfarin 109 (52.4)	DOACs 99 (47.6)
Hospitalization (n, %)	No	92 (84.4)	96 (97.0)	0.002
	Yes	17 (15.6)	3 (3.0)
	Bleeding	12 (70.6)	1 (33.3)
	Thrombosis	5 (29.4)	2 (66.7)
Bleeding severity (n, %)	No	82 (75.2)	79 (79.8)	0.270
	Minor	9 (8.3)	12 (12.1)
	Non-major, clinically relevant	15 (13.8)	7 (7.1)
	Major	3 (2.8)	1 (1.0)
Systemic embolism (n, %)	No	103 (94.5)	96 (97.0)	0.381
	Yes	6 (5.6)	3 (3.0)