Adherence to dabigatran etexilate in atrial fibrillation patients intended to undergo electrical cardioversion

Willemijn J. Comuth (Corresponding author), Moniek P.M. de Maat, Daan van de Kerkhof, Jerzy Malczynski, Steen Husted, Steen D. Kristensen, Anna Marie B. Münster

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4 Citations (Scopus)


Aims Effective anticoagulation in patients undergoing electrical cardioversion (ECV) for symptomatic atrial fibrillation is important to prevent adverse events. High medication adherence is a requirement. In patients with newly diagnosed atrial fibrillation (n = 169) who were intended to undergo ECV, the aim of this study was to measure self-reported short- and long-term adherence, evaluate whether dabigatran plasma concentrations reflect adherence, measure treatment satisfaction and assess whether adherence and treatment satisfaction are correlated. Methods and results Plasma concentrations (liquid-chromatography tandem mass spectrometry), the 8-point Morisky Medication Adherence Scale (MMAS-8) and the Anti-Clot Treatment Scale (ACTS) were measured after 3 weeks and 7 weeks of treatment. Combined mean peak (1-3 h after intake) and trough (10-16 h after intake) plasma concentrations were 175 (SD 109) ng/mL and 75 (SD 45) ng/mL, respectively. There was no relationship between short-term adherence (last 3 days) or long-term adherence (last 3-4 weeks) and plasma concentrations, unless the last intake was more than 48 h ago. After 7 weeks high, moderate, and low adherence, according to the MMAS-8, was seen in 74%, 21%, and 5% of patients, respectively. Treatment satisfaction was high (median ACTS score 68.5, range 46-75 points). Treatment satisfaction and adherence were not correlated. Conclusion The percentage of patients in the high adherence group (74%) was lower than expected, which is a matter of concern. Dabigatran plasma concentrations could not detect short- or long-term non-adherence, unless the drug was last taken more than 48 h ago. Treatment satisfaction did not correlate with adherence.

Original languageEnglish
Pages (from-to)91-99
Number of pages9
JournalEuropean Heart Journal - Cardiovascular Pharmacotherapy
Issue number2
Publication statusPublished - 1 Apr 2019


  • Antidepressive agents
  • Atrial fibrillation
  • Dabigatran
  • Drug interactions
  • Mass spectrometry
  • Medication adherence
  • Second generation
  • Prospective Studies
  • Humans
  • Self Report
  • Electric Countershock
  • Male
  • Treatment Outcome
  • Patient Satisfaction
  • Drug Monitoring/methods
  • Tandem Mass Spectrometry
  • Medication Adherence
  • Time Factors
  • Dabigatran/administration & dosage
  • Chromatography, Liquid
  • Female
  • Aged
  • Antithrombins/administration & dosage
  • Atrial Fibrillation/diagnosis


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