Table 5. Available real-world data that suggested patients’ adherence to DOACs.
| Study | Drugs | Methods | Patients included | Adherence percent (%) | Non-adherence percent (%) | Factors and outcomes associated with adherence |
|---|---|---|---|---|---|---|
| Emren, 2018 (21) | DOACs | 8-item Morisky Medication Adherence | 2,738 | 49.01 | 50.99 | Non-adherence had related to stroke (5.6% vs. 2.5%, P<0.001) and minor (21.2% vs. 11.1%, P<0.001) and major (6.1% vs. 3.7%, P=0.004) bleeding rates |
| Beyer-Westendorf, 2015 (22) | Rivaroxaban | Self-report | 1,204 | 81.48 | 18.52 | Most common reasons for treatment discontinuations were bleeding complications (30%), other side effects (24.2%) and diagnosis of stable sinus rhythm (9.9%) |
| Zalesak, 2013 (23) | Dabigatran | Self-report | 3,370 | 74.07 | 25.93 | Patients with a low-to-moderate risk of stroke or with a higher bleed risk had a higher likelihood of non-persistence (HR, 1.37; P<0.001; and HR, 1.24; P=0.016) |
| Gorst-Rasmussen, 2015 (24) | Dabigatran | PDC | 2,960 | 76.79 | 23.21 | Patients with a CHA2DS2-VASc score ≥2 were more adherent to medication regimes than patients with a score of 1 (PDC ratio, 1.12) and generally patients with higher morbidity showed more adherence |
| Yao, 2016 (25) | DOACs | PDC | 26,471 | 47.50 | 52.50 | Adherence to therapy appears to be most important in patients with CHA2DS2-VASc score ≥2, whereas the benefits of anticoagulation may not outweigh the harms in patients with CHA2DS2-VASc score 0 or 1 |
| Shore, 2015 (26) | Dabigatran | PDC | 5,376 | 72.21 | 27.79 | The proportion of adherent patients was higher at sites performing appropriate selection (75% vs. 69%), education (76% vs. 66%), and monitoring (77% vs. 65%) |
| Brown, 2016 (27) | DOACs | PDC | 4,066 | 60.82 | 39.18 | Rivaroxaban and apixaban had favorable profiles compared with dabigatran, and rivaroxaban appeared to have higher overall adherence among the DOACs |
| Sørensen, 2017 (28) | DOACs | PDC | 19,952 | 43.34 | 56.66 | Poor adherence of DOACS for both short- and long-periods leaves the patient at higher risk of thrombosis |
| Schulman, 2013 (15) | Dabigatran | PDC | 103 | 88.35 | 11.65 | Routine feedback from the pharmacies could inform the physician to improve the anticoagulant management |
DOACs, direct oral anticoagulant; HR, hazard ratio; PDC, proportion of days covered.