Direct Oral Anticoagulants in Non-Valvular Atrial Fibrillation: Insights from Real-World Data on Drug Interactions and Medication Adherence
(2026)
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- Direct oral anticoagulants (DOACs) have become the cornerstone of stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, their real-world efficacy and safety continue to be influenced by key factors such as drug–drug interactions (DDIs) and medication adherence. This thesis aimed to investigate these key determinants of DOAC use in patients with NVAF. First, a real-world study conducted in primary care setting in Belgium evaluated the prevalence of potential drug interactions in general practitioners’ prescriptions. About one in five prescriptions presented at least one interaction, most of which were pharmacodynamic. These findings highlight the frequent co-prescription of potentially interacting pharmacodynamic drug and underscore the importance of prioritizing the identification and review of these high-risk associations to support safer anticoagulation prescribing. Second, a systematic review and meta-analysis assessed whether a higher threshold for DOAC adherence (90%) provides greater clinical benefit compared with the conventionally used 80% threshold. While both thresholds were associated with a reduced risk of thromboembolic events, increasing the adherence threshold from 80% to 90% was not consistently associated with additional efficacy benefits, and no significant differences in safety outcomes were observed between the two thresholds. Finally, adherence and persistence to DOAC therapy were evaluated among both new and prevalent users of DOACs in France. Approximately one quarter of patients were non-adherent and non-persistent at the 80% threshold, regardless of user status. Suboptimal adherence and persistence remain highly prevalent and represent a challenge in real-world DOAC management as it may hamper DOACs’ efficacy and safety. This thesis highlights that optimizing the safe and effective use of DOACs in NVAF patients calls for improved identification and more thorough assessment of drug–drug interactions at the prescribing stage, combined with sustained and targeted efforts to enhance patient adherence.
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Fuchs, V. (2026). Direct Oral Anticoagulants in Non-Valvular Atrial Fibrillation: Insights from Real-World Data on Drug Interactions and Medication Adherence. https://hdl.handle.net/2078.5/281474