Vitamin K Antagonist versus Direct Oral Anticoagulants in Algerian Clinical Practice: A Field Survey and Retrospective Study on Hospitalized Patients

Background. Oral anticoagulants, including Vitamin K antagonists (VKAs) and Direct Oral Anticoagulants (DOACs), are widely prescribed for the prevention and treatment of thromboembolic diseases. VKAs have been the cornerstone for over six decades, but their usage is complicated by the need for regular INR monitoring and numerous interactions. DOACs, introduced in the Algerian market in 2013, offer several advantages, including fewer interactions and no need for routine monitoring. However, they are not reimbursed, posing financial barriers for patients. Methods. two studies were conducted : a field survey assessing physicians' prescribing practices, and a retrospective study of hospitalized patients’ medical records who received these anticoagulants. Results. The field survey highlighted that cost and lack of reimbursement were significant barriers to prescribing DOACs, despite their improved safety profile. Retrospective analysis showed that patients on DOACs, particularly those with CHA2DS2-VASc scores ≥3, experienced fewer major bleeding events compared to those on VKAs. DOAC-treated patients also had shorter hospital stays. Discussion. The survey reveals that anticoagulant prescribing practices vary based on the diagnosed pathology. VKAs remain the standard for valvular atrial fibrillation (VAF), while DOACs are primarily used for non-valvular atrial fibrillation (NVAF). The findings indicate that current prescribing practices align with international ESC guidelines; however, differences in bleeding event rates compared to the ARISTOTLE and ROCKET AF studies were noted. Despite the superior safety profile of DOACs— marked by fewer bleeding complications—and improved patient adherence, their adoption is hindered by high costs and lack of reimbursement. Physicians expressed a strong willingness to prescribe DOACs if financial barriers were removed. Conclusion: The study shows that DOACs, with their better safety profile, fewer interactions, and no need for regular monitoring, lead to shorter hospital stays compared to VKAs. However, their high cost and lack of reimbursement limit their use in Algeria. VKAs are more affordable but require frequent INR monitoring and are linked to higher bleeding risks. Reducing financial barriers to DOACs could improve healthcare outcomes and patient management.