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Background <p>Valvular heart disease frequently affects older adults and necessitates valve replacement surgery followed by anticoagulation therapy. Although direct oral anticoagulants (DOACs) are increasingly used for atrial fibrillation and venous thromboembolism, they are not approved for use in mechanical heart valves. This study evaluated anticoagulant adherence and clinical outcomes among older patients after valve replacement using Taiwan’s National Health Insurance data.</p> Methods <p>This retrospective cohort study used the Taiwan National Health Insurance Research Database and included 4,872 patients aged ≥ 65 years with valvular heart disease who underwent valve replacement between 2010 and 2020. Patients with a history of end-stage renal disease, venous thromboembolism, or ischemic stroke before the index surgery were excluded. Anticoagulant use after discharge was identified, and medication adherence was defined as prescriptions covering ≥ 80% of days during a fixed 180-day post-discharge window. Multivariable logistic regression and Cox proportional hazards models were used to evaluate factors associated with adherence and clinical outcomes, including mortality and readmissions.</p> Results <p>Among the included patients, 38.53% did not receive any oral anticoagulant after discharge. Warfarin users demonstrated higher adherence rates than DOAC users. Females and those aged ≥ 75 years showed better adherence. Nonadherence was more common among DOAC users (OR: 1.51; 95% CI: 1.08–2.11) and was associated with higher stroke-related readmissions (DOACs, 7.63%; warfarin, 6.20%), although causal relationships cannot be established. DOAC users had lower observed 1-year mortality rates (4.31% vs. 8.36%) and similar rates of major bleeding events (6.12% vs. 6.34%) compared with warfarin users.</p> Conclusions <p>Differences in anticoagulant adherence and clinical outcomes were observed among older patients following valve surgery. Warfarin users showed higher measured adherence, whereas DOAC users had lower observed mortality. Because treatment allocation was not randomized and adherence is closely related to treatment type, the independent effect of adherence on outcomes cannot be completely established. Therefore, these findings should be interpreted cautiously prospective studies should be conducted to elucidate the relationship between adherence and clinical outcomes.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月10日

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  • Jun-Neng Roan,
  • Yu-Sheng Hu,
  • Tzu-Jung Chuang,
  • Yi-Lin Wu,
  • Yi-Ching Yang,
  • Han-Chang Ku

摘要

Background

Valvular heart disease frequently affects older adults and necessitates valve replacement surgery followed by anticoagulation therapy. Although direct oral anticoagulants (DOACs) are increasingly used for atrial fibrillation and venous thromboembolism, they are not approved for use in mechanical heart valves. This study evaluated anticoagulant adherence and clinical outcomes among older patients after valve replacement using Taiwan’s National Health Insurance data.

Methods

This retrospective cohort study used the Taiwan National Health Insurance Research Database and included 4,872 patients aged ≥ 65 years with valvular heart disease who underwent valve replacement between 2010 and 2020. Patients with a history of end-stage renal disease, venous thromboembolism, or ischemic stroke before the index surgery were excluded. Anticoagulant use after discharge was identified, and medication adherence was defined as prescriptions covering ≥ 80% of days during a fixed 180-day post-discharge window. Multivariable logistic regression and Cox proportional hazards models were used to evaluate factors associated with adherence and clinical outcomes, including mortality and readmissions.

Results

Among the included patients, 38.53% did not receive any oral anticoagulant after discharge. Warfarin users demonstrated higher adherence rates than DOAC users. Females and those aged ≥ 75 years showed better adherence. Nonadherence was more common among DOAC users (OR: 1.51; 95% CI: 1.08–2.11) and was associated with higher stroke-related readmissions (DOACs, 7.63%; warfarin, 6.20%), although causal relationships cannot be established. DOAC users had lower observed 1-year mortality rates (4.31% vs. 8.36%) and similar rates of major bleeding events (6.12% vs. 6.34%) compared with warfarin users.

Conclusions

Differences in anticoagulant adherence and clinical outcomes were observed among older patients following valve surgery. Warfarin users showed higher measured adherence, whereas DOAC users had lower observed mortality. Because treatment allocation was not randomized and adherence is closely related to treatment type, the independent effect of adherence on outcomes cannot be completely established. Therefore, these findings should be interpreted cautiously prospective studies should be conducted to elucidate the relationship between adherence and clinical outcomes.