{
  "abstract": "Background: The Spanish Atlas of poor anticoagulation control reports that 48.3% of patients with non-valvular atrial fibrillation (NVAF) treated with vitamin K antagonists (VKAs) have suboptimal control, affecting about 251,000 patients and causing avoidable strokes, major bleeds, deaths and an annual burden close to €800 million. Expert societies call for indicators to detect poor control and timely switching to direct oral anticoagulants (DOACs). This study compares VKA-to-DOAC transition in Spain, the Valencian Community (VC) and one health department (Dep_05).\n\nMethods: Ecological drug-utilisation study using 2021–2024 consumption data for acenocoumarol, warfarin, dabigatran, rivaroxaban, apixaban and edoxaban, expressed as DDD/1,000 inhabitants/day. For each level, VKA DDD, DOAC DDD and DOAC share [DOAC/(DOAC+VKA)] were calculated as transition indicators.\n\nResults: In Spain, DOACs increased from 10.2 to 13.9 DDD/1,000/day between 2021 and 2024, while VKAs fell from 5.6 to 4.3, raising DOAC share from 64.5% to 76.2%. In the VC, DOAC share was consistently higher (66.9–78.2%), with lower VKA exposure (4.9 to 3.9) and the same 2024 DOAC level as Spain (13.9). Dep_05 showed the most advanced transition: DOACs represented 75.0% of oral anticoagulant DDD in 2023 and 79.4% in 2024, with the lowest VKA exposure (3.36 vs 3.87 in VC and 4.34 in Spain). Its mix was more DOAC-centred, with higher dabigatran, apixaban and edoxaban use and lower rivaroxaban use.\n\nConclusions: Spain is moving from VKAs to DOACs, but transition intensity differs by territory. The VC is ahead of the national pattern and Dep_05 shows an early-adopter profile, with lower residual VKA exposure at similar overall anticoagulant use. Since poor VKA control carries avoidable clinical/economic burden, residual risk is likely unevenly distributed by residence. Identifying organisational and policy factors behind faster transition could reduce territorial inequities and improve anticoagulation outcomes.\n\nKey messages: • Spain shows a clear territorial gradient in VKA-to-DOAC transition, with Valencia ahead and Dep_05 showing an early-adopter profile.\n\n• Residual VKA exposure may concentrate avoidable risk by residence, supporting policies to reduce inequities in anticoagulation quality.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "abstract",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "name": "S Granero Ortells"
    },
    {
      "name": "N Bermudez Repiso"
    },
    {
      "name": "I Barrachina Martinez"
    },
    {
      "name": "JL Trillo Mata"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dnzkn5tvsspng.bib",
  "cited_by": 0,
  "doi": "10.1093/eurpub/ckag169.1577",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13699300/",
  "id": "dnzkn5tvsspng",
  "issns": [
    "1101-1262",
    "1464-360X"
  ],
  "landing_url": "https://doi.org/10.1093/eurpub/ckag169.1577",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "6. Poster Displays"
    ],
    [
      "heading",
      "AcademicSubjects/MED00860"
    ],
    [
      "heading",
      "AcademicSubjects/SOC01210"
    ],
    [
      "heading",
      "AcademicSubjects/SOC02610"
    ],
    [
      "heading",
      "DM. Health services and systems research"
    ],
    [
      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
    ]
  ],
  "openalex": "W7223650525",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13699300/pdf/?tool=EBI",
  "pmcid": "PMC13699300",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/dnzkn5tvsspng.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:56Z",
      "native_id": "PMC13699300",
      "source": "pmc",
      "url": "https://doi.org/10.1093/eurpub/ckag169.1577"
    },
    {
      "first_seen": "2026-10-30T12:21:48Z",
      "native_id": "PMC:PMC13699300",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13699300"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Three speeds in VKA-to-DOAC transition: Spain, Valencia and one department, 2021–2024",
  "title_text": "Three speeds in VKA-to-DOAC transition: Spain, Valencia and one department, 2021–2024",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:35:54Z",
  "url": "https://research.draconitic.com/paper/dnzkn5tvsspng",
  "venue": "The European Journal of Public Health",
  "versions": []
}