Three speeds in VKA-to-DOAC transition: Spain, Valencia and one department, 2021–2024
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).
Methods: 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.
Results: 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.
Conclusions: 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.
Key messages: • Spain shows a clear territorial gradient in VKA-to-DOAC transition, with Valencia ahead and Dep_05 showing an early-adopter profile.
• Residual VKA exposure may concentrate avoidable risk by residence, supporting policies to reduce inequities in anticoagulation quality.
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BibTeX
@article{ortells2026three,
title = {{Three speeds in VKA-to-DOAC transition: Spain, Valencia and one department, 2021–2024}},
author = {S Granero Ortells and N Bermudez Repiso and I Barrachina Martinez and JL Trillo Mata},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1577},
url = {https://doi.org/10.1093/eurpub/ckag169.1577},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Three speeds in VKA-to-DOAC transition: Spain, Valencia and one department, 2021–2024
AU - S Granero Ortells
AU - N Bermudez Repiso
AU - I Barrachina Martinez
AU - JL Trillo Mata
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1577
UR - https://doi.org/10.1093/eurpub/ckag169.1577
AB - 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). Methods: 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. Results: 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. Conclusions: 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. Key messages: • Spain shows a clear territorial gradient in VKA-to-DOAC transition, with Valencia ahead and Dep_05 showing an early-adopter profile. • Residual VKA exposure may concentrate avoidable risk by residence, supporting policies to reduce inequities in anticoagulation quality.
SN - 1101-1262
SN - 1464-360X
ER -