Key result
DOACs yield modest adherence gains, leaving ~50% of eligible AF patients untreated.
Why the study?
Despite recommendations, only 50-60% of indicated AF patients receive oral anticoagulation and less than half adhere over time, with DOACs offering only modest improvements over VKAs.
Despite the introduction of DOACs, oral anticoagulation use and adherence remain suboptimal in high-risk patients with atrial fibrillation.
Ongoing OAC underuse in eligible AF patients warrants implementation focus; leaves open optimal strategies to boost adherence.
The most common arrhythmia, atrial fibrillation (AF), increases with age and is associated with a 5-fold increased risk of stroke. Although lifelong oral anticoagulation (OAC) is strongly recommended for stroke prevention in patients with AF and CHA2DS2-VASc ≥ 2 only 50–60% of patients in Western countries belonging to this group are treated with oral anticoagulants, and less than half of these adhere to therapy over time. Before 2010, the numerous limitations associated with vitamin K antagonists (VKAs) were considered to be the reason behind OAC underuse; however, the approval of direct oral anticoagulants (DOACs) that require once- or twice-daily intake, no regular blood tests and fewer drug–food interactions has resulted in only modest improvements in OAC use and adherence.
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Garot et al. (2023) conducted a review in Atrial Fibrillation. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated. Direct oral anticoagulants have resulted in only modest improvements in therapy adherence and use, with only 50-60% of eligible atrial fibrillation patients currently treated.
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