Impact of the COVID-19 lockdown on the adherence of stroke patients to direct oral anticoagulants: a secondary analysis from the MAAESTRO study

Fine Dietrich; Alexandros A Polymeris; Melina Verbeek; Stefan T Engelter; Kurt E Hersberger; Sabine Schaedelin; Isabelle Arnet; Philippe A Lyrer

doi:10.1007/s00415-021-10631-5

Impact of the COVID-19 lockdown on the adherence of stroke patients to direct oral anticoagulants: a secondary analysis from the MAAESTRO study

J Neurol. 2022 Jan;269(1):19-25. doi: 10.1007/s00415-021-10631-5. Epub 2021 Jun 3.

Authors

Affiliations

¹ Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, PO Box 2148, 4001, Basel, Switzerland. fine.dietrich@unibas.ch.
² Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland.
³ Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, PO Box 2148, 4001, Basel, Switzerland.
⁴ Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland.
⁵ Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.

^# Contributed equally.

Abstract

Background: The negative impact of the COVID-19 outbreak on stroke care has been reported, but no data exist on the influence of the lockdown on medication adherence to antithrombotic treatment for stroke prevention. We present a comparison of electronic adherence data of stroke patients treated with direct oral anticoagulants (DOAC) prior to and during the COVID-19 lockdown in spring 2020 in Switzerland.

Methods: This is a secondary analysis using data from the ongoing MAAESTRO study, in which stroke patients with atrial fibrillation electronically monitor their adherence to DOAC treatment. Eligible patients for this analysis had at least four weeks of adherence data prior to and during the COVID-19 lockdown. Three adherence metrics (taking adherence, timing adherence, drug holidays) were calculated and compared descriptively.

Results: The analysis included eight patients (median age 81.5 years, IQR 74.8-84.5). Five patients had a pre-lockdown taking adherence over 90% (mean 96.8% ± 2.9), with no change during lockdown, high timing adherence in both periods and no drug holidays. The remaining three patients had pre-lockdown taking and timing adherence below 90%. Of those, two patients showed a moderate decline either in taking or timing adherence compared to pre-lockdown. One showed a substantial increase in taking and timing adherence during lockdown (both + 25.8%).

Conclusion: Our data suggest that a major disruption of social life (i.e., the imposed COVID-19 lockdown) is unlikely to relevantly affect the medication intake behaviour of patients with high pre-established adherence, but might have an impact in patients with previously suboptimal adherence.

Trial registration number: MAAESTRO: electronic Monitoring and improvement of Adherence to direct oral Anticoagulant treatment-a randomized crossover study of an Educational and reminder-based intervention in ischaemic STROke patients under polypharmacy, NCT03344146.

Keywords: COVID-19; Direct oral anticoagulation; Electronic monitoring; Ischaemic stroke; Medication adherence.

MeSH terms

Administration, Oral
Aged, 80 and over
Anticoagulants / therapeutic use
Atrial Fibrillation* / complications
Atrial Fibrillation* / drug therapy
Brain Ischemia* / drug therapy
COVID-19*
Communicable Disease Control
Cross-Over Studies
Humans
Medication Adherence
SARS-CoV-2
Stroke* / drug therapy

Substances

Anticoagulants

Associated data

ClinicalTrials.gov/NCT03344146