International Journal of Clinical Pharmacy

, Volume 39, Issue 6, pp 1265–1272 | Cite as

Patients’ knowledge on oral anticoagulant treatment in Hungary

  • Reka ViolaEmail author
  • Helga Fekete
  • Ildiko Csoka
Research Article


Background A key element for an effective and safe oral anticoagulant treatment (OAT) is to have the relevant information delivered to patients in an easy-to-understand way and thus have them apply this knowledge in their own therapy. Objective To assess knowledge about OAT, reveal knowledge gaps and identify at-risk patients in terms of limited knowledge about their anticoagulant therapy. Setting Community pharmacies in Hungary. Methods This descriptive cross-sectional study used a structured, validated, self-developed questionnaire to assess patients’ knowledge about OAT. Scores were calculated on each domain and the association between knowledge and patients’ or treatment characteristics were analysed. Responses in all domains were assessed to identify at-risk patients and knowledge gaps. Main outcome measures Knowledge and knowledge gaps on OAT, and risk factors for limited knowledge. Results The questionnaire developed based on four validated questionnaires passed the field test and had a good internal consistency (Cronbach α = 0.795). Our full patient population (N = 427) had a mean percentage score of 59.39 (29.7% good, 41.2% average, 29.0% poor knowledge on OAT). Poor knowledge level was found to significantly correlate with advanced age (> 75 years), lower education, diagnosis of atrial fibrillation, and unawareness of the indication of OAT. The lowest frequency of correct answers regarded the questions on drug interactions (10.2%) and diet (11.4%). Pharmacists were infrequently indicated as the healthcare professionals to share information with regarding OAT (12.7%). Conclusion Findings of our study offer a valuable insight into the required directions of developing new strategies for patient education to improve knowledge on the treatment with oral anticoagulants.


Hungary Oral anticoagulant therapy Patient education Pharmaceutical care Therapy-related knowledge 



The authors are grateful to all participating patients and community pharmacists for their help in the implementation of this study. We thank Dora Bokor (PharmD) for proofreading the manuscript.


The study was supported by the grant Social Renewal Operational Programme’ 6.1.5-14-2015-0004 [Társadalmi Megújulás Operatív Program].

Conflicts of interest

None of the authors have any conflicts of interest to disclose.


  1. 1.
    Goldhaber SZ. Venous thromboembolism: epidemiology and magnitude of the problem. Best Pract Res Clin Haematol. 2012;25(3):235–42.CrossRefPubMedGoogle Scholar
  2. 2.
    Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, et al. Update the global burden of ischaemic and hemorrhagic stroke in 1990–2013: the GBD 2013 study. Neuroepidemiology. 2015;45(3):161–76.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bajorek B, Magin PJ, Hilmer S, Krass I. Utilization of antithrombotic therapy for stoke prevention in atrial fibrillation: a cross-sectional baseline analysis in general practice. J Clin Pharm Ther. 2016;41(4):432–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Hanemaaijer S, Sodihardjo F, Horikx A, Wensing M, De Smet PA, Bouvy ML, et al. Trends in antithrombotic drug use and adherence to non-vitamin K oral anticoagulants in the Netherlands. Int J Clin Pharm. 2015;37(6):1128–35.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hernandez Madrid A, Potpara TS, Dagres N, Chen J, Larsen TB, Estner H, et al. Diffrences in attitude, education, and knowledge about oral anticoagulation therapy among patients with atrial fibrillation in Europe: result of a self-assessment patient survey conducted by the European Heart Rhythm Association. Europace. 2016;18(3):463–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Rodriguez RA, Carrier M, Wells PS. Non-adherence to new oral anticoagulants: a reason for concern during long-term anticoagulation? J Thromb Haemost. 2013;11(2):390–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Yao X, Abraham NS, Alexander GC, Crown W, Montori V, Sangaralingham LR, et al. Effect of adherence to oral anticoagulants on risk of stroke and major bleeding among patients with atrial fibrillation. J Am Heart Assoc. 2016;5(2):e003074.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kagansky N, Knobler H, Rimon E, Ozer Z, Levy S. Safety of anticoagulation therapy in well-informed older patients. Arch Intern Med. 2004;164(18):2044–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Ewen S, Rettig-Ewen V, Mahfoud F, Boehm M, Laufs U. Drug adherence in patients taking oral anticoagulation therapy. Clin Res Cardiol. 2014;103(3):173–82.CrossRefPubMedGoogle Scholar
  10. 10.
    Wang Y, Kong MC, Lee LH, Ng HJ, Ko Y. Knowledge, satisfaction, and concerns regarding warfarin therapy and their association with warfarin adherence and anticoagulation control. Thromb Res. 2014;133(4):550–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Borg Xuereb C, Shaw RL, Lane DA. Patients’ and health professionals’ views and experiences of atrial fibrillation and oral-anticoagulant therapy. A qualitative meta-synthesis. Patient Educ Couns. 2012;88(2):330–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Kneeland PP, Fang MC. Current issues in patient adherence and persistence. Focus on anticoagulants for the treatment and prevention of thromboembolism. Patient Prefer Adherence. 2010;4:51–60.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Hedegaard U, Kjeldsen LJ, Pottegard A, Bak S, Hallas J. Multifaceted intervention including motivational interviewing to support medication adherence after stroke/transient ischemic attack: a randomized trial. Cerebrovasc Dis Extra. 2014;4(3):221–34.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Varnai R, Vegh M, Poto L, Nagy L. Level of knowledge among patients treated with oral anticoagulant. Orv Hetil. 2008;149(43):2047–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Alphonsa A, Sharma K, Sharma G, Bhatia R. Knowledge regarding oral anticoagulation therapy among patients with stroke and those at high risk of thromboembolic events. J Stroke Cerebrovasc Dis. 2015;24(3):668–72.CrossRefPubMedGoogle Scholar
  16. 16.
    Zeolla MM, Brodeur MR, Dominelli A, Haines ST, Allie ND. Development and validation of an instrument to determine patient knowledge. The oral anticoagulation knowledge test. Ann Pharmacother. 2006;40(4):633–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Briggs AL, Jackson TR, Bruce S, Shapiro NL. The development and performance validation of a tool to assess patient anticoagulation knowledge. Res Soc Adm Pharm. 2005;1(1):40–59.CrossRefGoogle Scholar
  18. 18.
    Chenot JF, Hua TC, Abed A, Schnider-Rudt H, Friede T, Schnider S, Vomfelde SV. Safety relevant knowledge of orally anticoagulated patients without self-monitoring: a baseline survey in primary care. BMC Fam Pract. 2014;25(15):104.CrossRefGoogle Scholar
  19. 19.
    Shrestha S, Sapkota B, Kumpakha A, Acharya U, Sharma R. Evaluation of patients’ knowledge on warfarin in outpatient pharmacy of a tertiary care cardiac center. BMC Res Notes. 2015;10(8):429–33.CrossRefGoogle Scholar
  20. 20.
    Fang MC, Machtinger EL, Wang F, Schillinger D. Health literacy and anticoagulation-related outcomes among patients taking warfarin. J Gen Intern Med. 2006;21(8):841–6.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mavri A, Ostasevski Fernandez N, Kramaric A, Kosmelj K. New educational approach for patients on warfarin improves knowledge and therapy control. Wien Klin Wochenschr. 2015;127(11–12):472–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Mayet AY. Association between oral anticoagulation knowledge, anticoagulation control, and demographic characteristics of patients attending an anticoagulation clinic in Saudi Arabia. A cross-sectional prospective evaluation. Trop J Pharm Res. 2015;14(7):285–91.CrossRefGoogle Scholar
  23. 23.
    Whelan W, Sahm L. Assessment of health literacy in patients receiving warfarin anticoagulation therapy and correlation of results with anticoagulant control. Eur J Hosp Pharm. 2012;19(2):249.CrossRefGoogle Scholar
  24. 24.
    Tang EO, Lai CS, Lee KK, Wong RS, Cheng G, Chan TY. Relationship between patients’ warfarin knowledge and anticoagulation control. Ann Pharmacother. 2003;37(1):34–9.CrossRefPubMedGoogle Scholar
  25. 25.
    National Institute of Health development [Internet]. Hungary: Health Report 2015 [cited 2017 Jan 30].
  26. 26.
    Hasan SS, Shamala R, Syed IA, Basariah N, Chong DW, Mei TK, Chin OH. Factors affecting warfarin-related knowledge and INR control of patients attending physician- and pharmacist-managed anticoagulation clinics. J Pharm Pract. 2011;24(5):485–93.CrossRefPubMedGoogle Scholar
  27. 27.
    National health Insurance Found of Hungary [Internet]. Hungary: Drug utilisation data [cited 2017 Jan 30].
  28. 28.
    Fang MC, Panguluri P, Machtinger EL, Schillinger D. Language, literacy, and characterization of stroke among patients taking warfarin for stroke prevention: implications for health communication. Patient Educ Couns. 2009;75(3):403–10.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Nicol MB, Thrift AG. Knowledge of risk factors and warning signs of stroke. Vasc Health Risk Manag. 2005;1(2):137–47.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Pharmaceutical Technology and Drug Regulatory AffairsUniversity of SzegedSzegedHungary

Personalised recommendations