Adherence to Direct Oral Anticoagulants in Patients With Non-valvular Atrial Fibrillation: A Single-Center Retrospective Study.

Authors

Cuie Chang, Sha Lv, Lingyan Yu, Lingcheng Xu, Donghang Xu, Haibin Dai, Junjun Xu

Published in

Journal of cardiovascular pharmacology and therapeutics. Volume 31. Pages 10742484261490639. Epub Sep 23, 2026.

Abstract

ObjectiveTo investigate adherence to four direct oral anticoagulants (DOACs) and its influencing factors in patients with non-valvular atrial fibrillation (NVAF), providing evidence for strategies to improve adherence.MethodsA retrospective cohort study included NVAF patients initiating DOAC therapy at a tertiary hospital (January 2016-November 2023). Adherence was evaluated using the proportion of days covered (PDC), with PDC ≥ 0.8 defined as good adherence. Adherence levels for dabigatran, rivaroxaban, apixaban, and edoxaban were compared at 3, 6, 9, and 12 months. Logistic regression identified factors influencing 1-year adherence, assessing the impact of initiation year and the National Volume-Based Drug Procurement (NVBP) policy.ResultsA total of 1,150 NVAF patients were enrolled (dabigatran: n = 401; rivaroxaban: n = 656; apixaban: n = 18; edoxaban: n = 75),In this main cohort, overall adherence progressively declined, with only 40.78% achieving PDC ≥ 0.8 at 1 year. Significant differences existed among groups (P<0.001). Dabigatran demonstrated the highest 1-year adherence (53.62%), followed by rivaroxaban (34.91%), apixaban (27.78%), and edoxaban (26.67%). Compared with dabigatran, rivaroxaban (OR=0.47) and edoxaban (OR=0.33) were independently associated with poorer adherence. Age ≥75 years (OR=0.62) and self-pay (OR=0.49) were risk factors for poor adherence, while diabetes (OR=1.48) and prior stroke (OR=1.48) predicted better adherence. Patients initiating therapy in 2017 showed the highest adherence. Post-NVBP, generic dabigatran adherence exceeded the original formulation at 6 months (P=0.038), but this difference disappeared at 1 and 2 years.ConclusionDOAC adherence among NVAF patients is suboptimal and decreases over time. Among the four DOACs, dabigatran was associated with the highest adherence. Elderly (≥75 years) and self-paying patients are at higher risk of poor adherence, whereas those with diabetes or stroke history show better adherence. The NVBP policy improves adherence short-term, but long-term effects are limited. Targeted interventions are necessary for high-risk populations.

PMID:
42777254
Bibliographic data and abstract were imported from PubMed on 24 Sep 2026.

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