Arrhythmias & electrophysiology

Compliance to direct oral anticoagulation therapy and clinical outcomes after catheter ablation for atrial fibrillation: a nationwide cohort study

EuropacePublished Nationwide cohort study

Authors' 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.

Study context

Population
Danish patients undergoing first-time catheter ablation for atrial fibrillation (AF), 2017–202432.1% female
Participants
13,438 patients
Outcome
Adherence (PDC ≥80%) and persistence (20% grace period) to direct oral anticoagulant (DOAC) therapy
Follow-up
1, 2 and 3 years after first-time catheter ablation
Methodological detailsregistry-based
  • Registry-based

Main finding

As reported in the abstract

DOAC adherence and persistence, CHA2DS2-VA ≥2 · 3 years post-ablation
GroupAdherence (proportion of days covered (PDC) ≥80%)Persistence
CHA2DS2-VA ≥287.6% (95% CI: 86.8-88.4)73.0% (95% CI: 71.6-74.4%)

CHA2DS2-VA ≥2

Adherence (proportion of days covered (PDC) ≥80%)87.6% (95% CI: 86.8-88.4)
Persistence73.0% (95% CI: 71.6-74.4%)

Observational data: associations, not effects.

Further findings

Adherence with PDC ≥90% threshold (sensitivity analysis) · 3 years post-ablation

Proportion adherent, PDC ≥90%
78.8% (95% CI: 77.8-79.8%)
  • Sensitivity analysis

Combined ischaemic stroke, TIA and systemic embolism

Total incidence rate
6.6 per 1000 person-years (95% CI: 5.8-7.4)

Safety

Major bleeding (combined cohort)

Incidence
7.1 per 1000 person-years (95% CI: 6.3-8.0)

Original publication

Compliance to direct oral anticoagulation therapy and clinical outcomes after catheter ablation for atrial fibrillation: a nationwide cohort study. Europace. Published 30 June 2026. doi:10.1093/europace/euag151

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