Missed dose of anticoagulant medication
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Missed Anticoagulant Dose: Clinical Impact and Adherence Patterns
Missed Dose of Anticoagulant Medication: Risks and Outcomes
Missing doses of anticoagulant medication, especially direct oral anticoagulants (DOACs), can significantly increase the risk of adverse events. Studies show that patients who miss doses or take lower-than-recommended doses of DOACs have a higher risk of major vessel occlusion and recurrent ischemic stroke, particularly in those with atrial fibrillation or a history of stroke 34. Nonrecommended dosing, including both underdosing and overdosing, is also linked to increased all-cause mortality, mainly from cardiovascular causes . Even missing more than 5% of prescribed doses is associated with a higher risk of thromboembolic events .
Prevalence and Patterns of Missed Doses
Missed doses of anticoagulants are common in both hospital and outpatient settings. In hospitals, subcutaneous anticoagulants are more likely to be missed compared to other medications, with patient refusal being the most frequent reason . In real-world settings, about 24% of patients with atrial fibrillation are prescribed off-label doses of DOACs, with underdosing being more common than overdosing . This trend is especially pronounced in Asia, where clinicians are more likely to prescribe lower doses .
Barriers to Anticoagulant Adherence
Barriers to adherence are widespread among patients of all ages. In pediatric and adolescent populations, nearly 75% of patients and caregivers report at least one barrier to taking anticoagulants as prescribed 56. Common barriers include medication side effects, lifestyle disruptions, and simply forgetting to take the medication . The more barriers a patient faces, the more likely they are to miss doses 56. These findings highlight the importance of addressing individual barriers to improve adherence and reduce the risk of complications.
Dosing Regimens and Missed Dose Management
There is ongoing debate about whether once-daily or twice-daily dosing regimens are better for patient adherence. Evidence suggests no significant difference in efficacy or safety between these regimens, but some clinicians prefer twice-daily dosing to maintain more stable drug levels in case a dose is missed . New model-informed approaches and web-based tools are being developed to help clinicians manage delayed or missed doses more effectively, aiming to minimize the time patients spend outside the therapeutic window .
Conclusion
Missing doses of anticoagulant medication, especially DOACs, is common and can lead to serious health risks, including stroke and increased mortality. Barriers to adherence are frequent and diverse, affecting both children and adults. Addressing these barriers and using evidence-based strategies for managing missed doses are essential to ensure the safety and effectiveness of anticoagulant therapy.
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