{"id":"502ab223879c","type":"article","url":"https://hartvaat.nl/2026/06/02/doac-gebruik-na-ablatie-voor-atriumfibrilleren-aanhouderij-daalt-na-drie-jaar/","title":"DOAC-gebruik na ablatie voor atriumfibrilleren: aanhouderij daalt na drie jaar","title_en":"Compliance to direct oral anticoagulation therapy and clinical outcomes after catheter ablation for atrial fibrillation: a nationwide cohort study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euag151","source_url":"https://doi.org/10.1093/europace/euag151","authors":["Bjarke Sihm Stender","Victor Kjær Eskildsen","Anders Kramer","Maja Hellfritzsch Poulsen","Kasper Korsholm","Kasper Bonnesen","Morten Schmidt","Mads Brix Kronborg","Jens Erik Nielsen-Kudsk"],"significance":5,"published":"2026-08-11","source_date":"2026-06-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"A nationwide Danish cohort of 13,438 patients undergoing first-time catheter ablation for atrial fibrillation was analysed for DOAC adherence and persistence, focusing on those with a CHA₂DS₂-VASc score ≥2. After three years, 87.6% met the adherence threshold (PDC ≥80%), but persistence dropped to 73.0%, indicating that over 20% had discontinued therapy. Thromboembolic and major bleeding rates remained low. The findings highlight a need for structured follow-up and adherence support to maintain long-term stroke prevention after AF ablation.","created":"2026-08-05T00:56:48Z","updated":"2026-08-10T10:36:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een Deense cohortstudie van 13.438 patiënten die voor het eerst werden geablateerd voor atriumfibrilleren, werd de aanhouderij van DOAC's geëvalueerd bij patiënten met een CHA₂DS₂-VASc-score ≥2. Na drie jaar voldeed 87,6% aan de eis voor adherentie (PDC ≥80%), maar de persistentie daalde tot 73,0%, wat betekent dat meer dan 20% het middel niet meer innam. Deze bevindingen onderstrepen dat structurele ondersteuning nodig is om de medicatietrouw na ablatie op peil te houden, wat direct relevant is voor de dagelijkse praktijk.","abstract_original":"BACKGROUND AND AIMS: Life-long direct oral anticoagulant (DOAC) therapy is recommended after catheter ablation for atrial fibrillation (AF) in high-risk patients (CHA2DS2-VA≥2). Long-term DOAC compliance is crucial for effective stroke prevention. This study seeks to evaluate long-term compliance measured by adherence and persistence to DOAC therapy following first-time catheter abltation for AF. METHODS AND RESULTS: All Danish patients undergoing first-time catheter ablation between 2017 and 2024 were identified through Danish registries. Patients were stratified by CHA2DS2-VA score 0, 1, and ≥2. Primary outcomes were adherence and persistence to DOAC therapy at 1, 2, and 3 years after first-time catheter ablation. Adherence was defined as the proportion of days covered (PDC) ≥80%. Persistence was assessed as the proportion of patients covered based on the most recent pharmacy redemption before specific time points, given a 20% grace period. A total of 13 438 patients (32.1% female) were included. At 3 years post-ablation, the proportion of adherent patients with CHA2DS2-VA ≥2 (n = 7322) was 87.6% [95% cinfidence interval (CI): 86.8-88.4]. Applying a sensitivity analysis with a PDC ≥90% threshold, the proportion was 78.8% (95% CI: 77.8-79.8%). Persistence was 73.0% (95% CI: 71.6-74.4%) at 3 years. Rates of thromboembolic outcomes were low with a total incidence rate of the combined outcome of ischaemic stroke, transient ischaemic attack and systemic embolism at 6.6 per 1000 person-years (95% CI: 5.8-7.4). The incidence of major bleeding was found at 7.1 per 1000 person-years (95% CI: 6.3-8.0) for the combined cohort. CONCLUSION: While adherence to DOAC therapy was acceptable in patients with CHA2DS2-VA≥2, persistence declined over time and more than 20% were non-persistent by 3 years. Efforts to improve effective long-term stroke prevention may be warranted. UNSTRUCTURED ABSTRACT: Life-long direct oral anticoagulant (DOAC) therapy is recommended after catheter ablation for atrial fibrillation in high-risk patients (CHA2DS2-VA≥2). Adherence and persistence to DOAC is crucial for effective stroke prevention.Danish patients undergoing first-time catheter ablation between 2017 and 2024 were identified through registries.A total of 13 438 patients were included. At 3 years post-ablation, the proportion of adherent and persistent patients with CHA2DS2-VA ≥2 (n = 7322) was 87.6% and 73.0%, respectively.Adherence to DOAC was acceptable in patients with CHA2DS2-VA≥2. More than 20% of patients were non-persistent by 3 years. Efforts to improve effective long-term stroke prevention may be warranted."}