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

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.