[Comparison of therapy adherence in patients suffering from atrial fibrillation treated with direct oral anticoagulants based on data from years 2015-2018].

Abstract

Introduction: Direct oral anticoagulants are playing a significant role in the treatment of non-valvular atrial fibrillation for stroke prevention. Previous studies have demonstrated that adherence to direct anticoagulant therapy is better than that of vitamin K antagonists, however, it remains suboptimal. Objective: The authors aimed to examine the persistence of direct anticoagulant therapy in patients with atrial fibrillation by analyzing the National Health Insurance Fund Administration database. Method: We analyzed data from patients receiving direct anticoagulant therapy between 2015 and 2018 using the database of the National Health Insurance Fund Administration. The study considered both newly treated patients and those previously receiving direct anticoagulant therapy. Patients’ medication refills were tracked for 14 months, and persistence changes were evaluated using Kaplan–Meier analysis. The average duration of drug intake and its 95% confidence interval were determined for each active substance. Results: The one-year persistence of newly initiated direct anticoagulant therapy was 63.4% on average, while it was 71.1% among previously treated patients. The one-year average persistence was 7.7 percentage points higher in previously treated patients compared to those newly initiated on direct anticoagulant therapy. This advantage was +4.9 percentage points for apixaban, +9.5 percentage points for dabigatran, and +9.4 percentage points for rivaroxaban. The best one-year persistence in both groups was observed in 2017 (65.7% and 72.5%, respectively). Among newly treated patients, the average persistence rates were 61.5% for apixaban, 57.7% for dabigatran, and 62.9% for rivaroxaban. In previously treated patients, the one-year average persistence rates were 66.4% for apixaban, 67.4% for dabigatran, and 72.3% for rivaroxaban. The mean duration of drug intake over a 360-day period was 299 days for new patients and 322 days for previously treated patients. Conclusion: Differences were observed in one-year persistence among the various direct anticoagulants. However, in general, therapy adherence to direct anticoagulants has increased since 2016. Nonetheless, significant efforts are required to further improve persistence rates. Orv Hetil. 2025; 166(21): 808–816.