Medication adherence and treatment persistence following switching from vitamin K antagonists to direct oral anticoagulants: a systematic review.
8 affiliations
- 1Department of Pharmacy, Faculty of Medical Sciences, Al-Ruwad University, Taiz, Republic of Yemen. [email protected].
- 2Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.
- 3Department of Hospital and Clinical Pharmacy, Faculty of Pharmacy, University of Cyberjaya, Cyberjaya, Malaysia.
- 4Drug Supply Department, Hamad Medical Corporation, Doha, Qatar.
- 5College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
- 6Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
- 7Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
- 8Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, Indonesia.
Abstract
Background
Switching from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs) has become increasingly common because of the limitations associated with VKA therapy. However, adherence and persistence after switching remain important determinants of treatment effectiveness. This systematic review evaluated adherence and persistence outcomes following switching from VKAs to DOACs and summarized the reported reasons for switching.Methods
A systematic review was conducted in accordance with PRISMA guidelines. PubMed and Scopus were searched for studies published between January 2016 and April 2026 evaluating adherence or persistence following switching from VKAs to DOACs. Eligible studies included randomized and observational studies involving adult patients with atrial fibrillation, venous thromboembolism, or other indications requiring anticoagulation therapy. Data on study characteristics, adherence and persistence outcomes (including proportion of days covered, medication possession ratio, and discontinuation measures), and reasons for switching were extracted and synthesized narratively.Results
Sixteen studies were included. Adherence was assessed using both objective refill-based measures and subjective patient-reported tools. Objective adherence rates were generally moderate to high, with the proportion of patients achieving proportion of days covered (PDC) ≥ 80% ranging from 76% to 97.5% across most studies. Studies using subjective patient-reported instruments, including MMAS-8, ACTS, and PACT-Q2, reported more variable adherence levels. Persistence rates ranged from 54% to 94%, although substantial variability in persistence definitions and follow-up duration limited direct comparison across studies. Poor international normalized ratio control and low time in therapeutic range were the most commonly reported reasons for switching from VKAs to DOACs.Conclusions
Studies evaluating switching from VKAs to DOACs generally reported moderate-to-high objective adherence rates, although persistence outcomes and subjective adherence measures were more variable. Methodological heterogeneity across studies highlights the need for standardized evaluation approaches and continued adherence-support strategies after switching.
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BibTeX
@article{alaqab2026medication,
title = {{Medication adherence and treatment persistence following switching from vitamin K antagonists to direct oral anticoagulants: a systematic review.}},
author = {Ahmed Alaqab and Mohammed Alfaqeeh and Rosnani Hashim and Maali Mustafa and Anas Hamad and Niveen M E Abu-Rmeileh and Rizky Abdulah and Sofa D Alfian},
journal = {BMC cardiovascular disorders},
year = {2026},
month = aug,
doi = {10.1186/s12872-026-06398-0},
url = {https://europepmc.org/article/MED/42958070},
note = {CC BY},
}
RIS
TY - JOUR
TI - Medication adherence and treatment persistence following switching from vitamin K antagonists to direct oral anticoagulants: a systematic review.
AU - Ahmed Alaqab
AU - Mohammed Alfaqeeh
AU - Rosnani Hashim
AU - Maali Mustafa
AU - Anas Hamad
AU - Niveen M E Abu-Rmeileh
AU - Rizky Abdulah
AU - Sofa D Alfian
PY - 2026
DA - 2026/08/01
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06398-0
UR - https://europepmc.org/article/MED/42958070
AB - Background Switching from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs) has become increasingly common because of the limitations associated with VKA therapy. However, adherence and persistence after switching remain important determinants of treatment effectiveness. This systematic review evaluated adherence and persistence outcomes following switching from VKAs to DOACs and summarized the reported reasons for switching.Methods A systematic review was conducted in accordance with PRISMA guidelines. PubMed and Scopus were searched for studies published between January 2016 and April 2026 evaluating adherence or persistence following switching from VKAs to DOACs. Eligible studies included randomized and observational studies involving adult patients with atrial fibrillation, venous thromboembolism, or other indications requiring anticoagulation therapy. Data on study characteristics, adherence and persistence outcomes (including proportion of days covered, medication possession ratio, and discontinuation measures), and reasons for switching were extracted and synthesized narratively.Results Sixteen studies were included. Adherence was assessed using both objective refill-based measures and subjective patient-reported tools. Objective adherence rates were generally moderate to high, with the proportion of patients achieving proportion of days covered (PDC) ≥ 80% ranging from 76% to 97.5% across most studies. Studies using subjective patient-reported instruments, including MMAS-8, ACTS, and PACT-Q2, reported more variable adherence levels. Persistence rates ranged from 54% to 94%, although substantial variability in persistence definitions and follow-up duration limited direct comparison across studies. Poor international normalized ratio control and low time in therapeutic range were the most commonly reported reasons for switching from VKAs to DOACs.Conclusions Studies evaluating switching from VKAs to DOACs generally reported moderate-to-high objective adherence rates, although persistence outcomes and subjective adherence measures were more variable. Methodological heterogeneity across studies highlights the need for standardized evaluation approaches and continued adherence-support strategies after switching.
SN - 1471-2261
ER -