Effectiveness of nursing strategies to promote therapeutic adherence to vitamin K antagonists: A systematic review

Abstract

Background: The incorporation of anticoagulant therapies into clinical practice has played a crucial role in reducing and preventing venous thromboembolic, cerebrovascular, and cardiopulmonary events, as well as their subsequent adverse outcomes in patients with prothrombotic conditions. Furthermore, the need for regular monitoring to maintain adequate anticoagulation levels presents a challenge in the use of vitamin K antagonists (VKAs). This study aimed to evaluate the effectiveness of strategies developed by nurses to promote therapeutic adherence to VKAs.

Methods: A comprehensive systematic review was conducted using the LILACS, BDENF, MEDLINE, ScienceDirect, and CINAHL databases. Study selection and sampling in the electronic databases were assisted by the Rayyan software. The review protocol was registered in the PROSPERO database (identifier CRD42024545808), and the report followed PRISMA guidelines.

Results: Evidence indicates that nurse-led interventions increase patients knowledge about the therapy, improve adherence to treatment and INR monitoring, extend the time within the therapeutic range, and reduce the risk of adverse outcomes related to the therapy.

Conclusion: Although more robust studies, such as multicenter randomized clinical trials, are needed, current evidence suggests that nurse-led interventions are effective and safe in promoting therapeutic adherence.

Keywords: Adherence therapeutic; Anticoagulants; Cardiovascular nursing; Nursing care; Warfarin.