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April 12, 2026BMC GeriatricsOpen Access

Anticoagulant adherence and associated complications and readmissions in older valve surgery adults: insights from a retrospective cohort study

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Why the study?

Does the use of DOACs compared to warfarin affect medication adherence, mortality, and readmissions in older adults following valve replacement surgery?

Population

4,872 patients aged ≥ 65 years with valvular heart disease who underwent valve replacement between 2010 and…

Comparison

Direct oral anticoagulants prescribed after… vs Warfarin prescribed after discharge

Design

Cohort

Follow-up

1 year

Authors

JRJun-Neng RoanYHYu-Sheng HuTCTzu-Jung Chuang

Discussion

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Overview

In older adults following valve replacement surgery, DOAC use was associated with lower medication adherence but lower 1-year mortality compared to warfarin, though the observational design limits causal inference.

Key Points

  • This study aims to evaluate anticoagulant adherence and associated clinical outcomes in older adults after valve replacement surgery.
  • Analysis of Taiwan National Health Insurance Research Database.
  • Inclusion of 4,872 patients aged ≥ 65 years with valvular heart disease following valve replacement.
  • Data collection on anticoagulant use and adherence defined as ≥ 80% coverage over 180 days post-discharge.
  • Application of multivariable logistic regression and Cox proportional hazards models for outcome evaluation.
  • 38.53% of patients did not receive any oral anticoagulant after discharge.
  • Higher adherence rates observed among warfarin users compared to DOAC users.
  • Nonadherence more prevalent among DOAC users, linked to higher stroke-related readmissions.
  • DOAC users had lower 1-year mortality rates compared to warfarin users (4.31% vs. 8.36%).

Structured PICO

Does the use of DOACs compared to warfarin affect medication adherence, mortality, and readmissions in older adults following valve replacement surgery?

P
Population
4,872 patients aged ≥ 65 years with valvular heart disease who underwent valve replacement between 2010 and 2020. Excluded: history of end-stage renal disease, venous thromboembolism, or ischemic stroke before the index surgery.
I
Intervention
Direct oral anticoagulants (DOACs) prescribed after discharge
C
Comparator
Warfarin prescribed after discharge
O
Outcome
Anticoagulant adherence (defined as prescriptions covering ≥ 80% of days during a fixed 180-day post-discharge window) and clinical outcomes including mortality and readmissionshard clinical

In older adults following valve replacement surgery, DOAC use was associated with lower medication adherence but lower 1-year mortality compared to warfarin, though the observational design limits causal inference.

Limitations

  • Treatment allocation was not randomized
  • Adherence is closely related to treatment type, so the independent effect of adherence on outcomes cannot be completely established
  • Causal relationships cannot be established

Cite This Study

Roan et al. (2026) studied this question.

synapsesocial.com/papers/69db365c4fe01fead37c47dchttps://doi.org/10.1186/s12877-026-07399-6
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