Adherence to oral anticoagulants for treatment of atrial fibrillation in the Middle East: a systematic review

Abdel Rahman Medani, Anthony Cox, Zahraa Jalal

Research output: Other contribution

78 Downloads (Pure)


Review question
To assess the atrial fibrillation patients’ adherence to oral anticoagulants in the Middle East.

Published articles in peered reviewed journals were searched systematically. The purpose of this organized search was to obtain published research articles about oral anticoagulants and adherence of patients with AF. The search also looked at how the adherence was measured. Several databases were used in the search including PubMed, PubMed Central UK, Embase, ScienceDirect, and Google Scholars. The period of time which was covered with the searched was from 01/01/2009 to 31/12/2018. Selection of these dates is justified by the first authorisation of Dabigatran, which was the first NOAC to be used.

Types of study to be included
Publications in the journals which included articles that studied adherence to oral anticoagulants in AF population. The designs of the selected studies are: analytical cross-sectional, descriptive cross-sectional, retrospective cohort studies, and prospective cohort studies.

Condition or domain being studied
Atrial fibrillation AF is the major type of arrhythmia that affects the human heart. It affects about 1% of the world population. The disease is a risk factor for stroke which can be a disabling condition and can cause death. The numbers of individuals affected by the condition is increasing around the world. By 2050 the total number of patients who suffer (AF) is expected to be about 16 million in the United States alone. These figures are candidate for further escalation in the forthcoming future.

The study population in selected studies is patients who are diagnosed with atrial fibrillation (AF) and who are prescribed oral anticoagulants for prevention of stroke. The selected publications also include published data about adult patients, residents in the Middle East, receiving their treatment in the Middle East, and publications are English language. Data from registries from other parts of the world which included patients from the Middle East were not included. Also publications about other type of anticoagulants (e.g. parental), and publications not in English are excluded.

Intervention(s), exposure(s)
The interventions of the selected studies are: assessing adherence of patients to prescribed oral anticoagulants, identifying reasons for non-adherence to oral anticoagulants, testing knowledge about oral anticoagulants, and assessing perception about oral anticoagulants.

Not applicable.

Main outcome(s)
Adherence to prescribed oral anticoagulants will be most important. Factors associated with adherence such levels of knowledge, and patients' beliefs about their oral anticoagulants will be investigated.

Timing and effect measures
These factors will be assessed on using validated questionnaires and scales specified for assessing these factors.

Additional outcome(s)
Types of prescribed oral anticoagulants, other factors that may appear, prescribing patterns, obstacles and limitations

Timing and effect measures
Frequencies and percentages of prescribed oral anticoagulant will be calculated.

Data extraction (selection and coding)
Abstracts and titles of the articles were screened to select the publications. Relevant studies were nominated through the following process: studies about patients who use oral anticoagulants, studies describing adherence to oral anticoagulants, interventions to improve adherence to oral anticoagulants, studies evaluating knowledge and perception, also adherence to prescribing guidelines. Selection of studies was in English language.

Risk of bias (quality) assessment
The Joanna Briggs tool for cross-sectional studies will be used. This will be undertaken by the main researcher (me) and reviewed by a second (supervisor). If any discrepancies arise then a third researcher will be consulted.

Strategy for data synthesis
Aggregate data will be used and a narrative-descriptive synthesis is planned. We do not anticipate a meta-analysis to be possible. There are three researchers involved in this work, the main researcher (me) will conduct and identify initial screening of titles and abstracts, derive full text articles, conduct data extraction and synthesise and analyse the data. The other researcher will check the process of data extraction through out and any discrepancies will be resolved by a third researcher. Tabulated extracted data will include, country of the study, type of the study, studied oral anticoagulant(s), number of patients/subjects included in the study, tools that used for measuring the adherence, and results/outcomes of the study.
Analysis of subgroups or subsets
No. of paramerters will be calculated, for examples total number of patients, proportions of each oral anticoagulant, measuring adherence methods, proportion of patient used in each methods, frequencies of co-morbidities associated.
Original languageEnglish
Media of outputProspero
Place of PublicationPROSPERO
Publication statusPublished - 21 May 2019


Dive into the research topics of 'Adherence to oral anticoagulants for treatment of atrial fibrillation in the Middle East: a systematic review'. Together they form a unique fingerprint.

Cite this