Fatores relacionados à adesão ao uso de varfarina em pacientes acometidos por acidente vascular encefálico: revisão integrativa

Abstract

Stroke is a medical emergency responsible for a high rate of mortality and disability for which it is necessary to implement secondary prevention to avoid recurrence of cases. Warfarin is a drug from the class of anticoagulants frequently used in the management of patients suffering from stroke in the context of the public health service for preventive purposes. However, its narrow safety range entails the need for continuous pharmacological surveillance. Therefore, the patient's adherence to the treatment becomes an important factor for the success of the therapy. The objective of the present study is to identify the factors related to adherence to the use of warfarin by patients affected by this disease described in the literature. This is an integrative review of the literature in the databases: National Library of Medicine (PUBMED); Scientific Electronic Library Online (SciELO); Scopus; Science Direct and Cochrane, using the controlled descriptors “Stroke”, “Warfarin” and “Medication Adherence”. The data collection period was from February to April 2023, with the aid of an adapted data collection instrument. Data analysis took place through exhaustive reading of the publications and the discussion was based on the relevant literature on the subject. Fifteen articles were selected, which show that adherence to the use of warfarin is multifactorial, related to intrinsic and extrinsic issues to the patient. It is concluded that the main factors promoting adherence are: higher frequency of medical appointments; shared decision-making about treatment; well-structured family support network and health education. The factors that hinder adherence are impaired access to the health system, the fragility of the family support network, the presence of comorbidities and low health literacy. Further studies on the subject are needed to further determine the factors, but health education activities are an important tool for professionals to maintain adherence to treatment.