OBJECTIVES: To explore perceptions of patients with nonvalvular atrial fibrillation (NVAF) who use or discontinued warfarin to gain insight into reasons for adherence, discontinuation and switching.
METHODS: Two focus groups were conducted with 8 participants greater than or equal to 18 years (total n = 16) self-reporting a NVAF diagnosis for greater then or equal to 6 months and warfarin use for greater than or equal to 3 months within the past year. Perceptions of oral anticoagulant (OAC) effectiveness, risk/adverse events (AEs) and treatment satisfaction and reasons for adherence and discontinuation were explored.
RESULTS: Eight (50%) participants were female. The mean age was 65.6±11.0 years. 87.5% (n= 14) of participants had NVAF diagnosis for greater than or equal to 5 years, and 56.3% (n= 9) participants currently used warfarin whereas 43.8% (n= 7) discontinued it but currently used a non-vitamin K antagonist oral anticoagulant (NOAC), including apixaban (n= 3), rivaroxaban (n= 2), or dabigatran (n= 2). Switches to NOACs were due to unstable clotting times (n= 5), bleeding events requiring hospitalization (n= 2), or problems with vein access for blood testing (n= 2). Effectiveness in preventing stroke or blood clots and low risk of treatment-related bleeds were the most important OAC attributes, with stroke protection being the primary reason for OAC adherence. Reported AEs included bruising, increased bleeding and longer healing time for cuts. 93.8% (n= 15) participants were satisfied with their current OAC. However, warfarin users were dissatisfied with clotting-time testing (due to inconvenience, expense and pain), food restrictions and dose adjustments. Users of all OACs noted being dissatisfied with bruising, bleeding risk and worrying about falls or cuts.
CONCLUSIONS: Established OAC users reported being satisfied and perceived their OAC as effective with low bleeding risk. Users who switched from warfarin to a NOAC reported increased satisfaction related to the lack of clotting-time testing and no dietary restrictions. All OAC users reported dissatisfaction related to worry about bleeding risk.
