[THE COMPLIANCE AND ADHERENCE TO DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH A TRIAL FIBRILLATION AFTER HOSPITALIZATION].

Introduction: Guidelines recommend direct oral anticoagulants (DOACs) for the treatment of non-valvular atrial fibrillation. The heads of the medicine wards in Beilinson Hospital were nominated for regulatory approval of these agents for Clalit Health Services (CHS) patients.

Objectives: To estimate the short and long term compliance and adherence to DOACs, and their association with the approval during hospitalization.

Methods: A retrospective study was conducted on patients hospitalized at the medical wards of Beilinson Hospital during 2017 and the first 6 months of 2018. Inclusion criteria: age>18 years, members of CHS, have non-valvular atrial fibrillation and DOACs were started during their hospitalization. Data was evaluated for: the rate of approvals during hospitalization, the time needed for it after discharge, the 30 days and 12 months compliance and adherence to DOACs agents and their association with approval during hospitalization.

Results: During the study period DOACs were started in 373 patients; 263 (71%) of them were included in the study: 59 patients (23%) received the approval during hospitalization, while 204 (77%) received it after discharge within a median of 3 days (range 1-10). There were no significant differences between the two groups concerning demographic, clinical parameters or length of stay. The DOACs 30-days compliance was 60% and 12-months adherence was 57%. There was a slight association between 30 days compliance and in-hospital approval (63% vs. 57%, p=0.3), while the 12 months adherence revealed the opposite (54% vs. 61%, p=0.5).

Conclusions: The short and long term compliance and adherence to DOACs is poor, regardless of the timing of the regulatory approval.

Discussion: These findings represent the real world situation, other studies revealed different results according to the study populations and methods.