Medication adherence to rivaroxaban and dabigatran in patients with non-valvular atrial fibrillation: a meta-analysis

  • Ashley Prentice
  • Irene Ruiz
  • Erin R. WeedaEmail author


Several real-world studies have evaluated adherence to direct acting oral anticoagulants in patients with non-valvular atrial fibrillation (NVAF); however, these studies have not been systematically summarized. We performed a meta-analysis to compare adherence to rivaroxaban versus dabigatran therapy in United States (US) patients with NVAF in a real-world setting. Medline and Scopus were searched from January 2010 to August 2018 using keywords and MeSH terms related to adherence and oral anticoagulants. We included real-world studies of US adults with NVAF comparing adherence to dabigatran and rivaroxaban. Studies evaluating adherence by a measure other than proportion of days covered (PDC) were excluded. The proportion of patients with a PDC ≥ 80 (a commonly utilized definition of adherence) served as the primary outcome of interest. We conducted meta-analysis of non-overlapping studies using the Hartung–Knapp random-effects model to estimate risk ratios (RRs) with corresponding 95% confidence intervals (CIs). We included 5 studies evaluating 80,230 patients (range 2667–22,571). Median follow-up across studies was 6 months (range 3–12 months). The proportion of patients with a PDC ≥ 80 ranged from 59.5 to 83.5% for rivaroxaban users and 57.3 to 78.3% for dabigatran users. Upon meta-analysis, rivaroxaban use was associated with increased adherence compared with dabigatran use (RR  1.08; 95% CI  1.03–1.12; I2 = 88%). In conclusion, rivaroxaban was associated with increased adherence when compared to dabigatran in ~ 80,000 patients in a real-world setting. Possible explanations for this include dosing frequency or patient tolerance.


Medication adherence Direct oral anticoagulant Atrial fibrillation Proportion of days covered 




Compliance with ethical standards

Conflicts of interest

Dr. Weeda has received research funding from Pfizer Inc. No other authors report conflicts of interest.

Supplementary material

11239_2019_1986_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.College of PharmacyMedical University of South CarolinaCharlestonUSA

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