Electronic Monitoring of Medication Adherence to Direct Oral Anticoagulants: A Systematic Review

Eliska Maskova, Simona Slivarichova, Josef Maly, Katerina Mala-Ladova Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech RepublicCorrespondence: Katerina Mala-Ladova, Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Akademika Heyrovského 1203, Hradec Králové, 500 03, Czech Republic, Tel +420 495 067 486, Email [email protected]: Strict medication adherence, which reflects the process by which patients take their medication as prescribed, is crucial for the use of direct oral anticoagulants (DOACs). Therefore, technological devices may serve as promising tools for assessing adherence. We aimed to systematically review the literature focusing on electronically monitored adherence (EMA) to DOACs. All studies indexed in EMBASE, Cochrane Library, MEDLINE, Scopus, and Web of Science from inception until September 1, 2023, were searched. Original studies targeting the query topics were included, findings were categorized and narratively synthetized. Adherence data, including the quality of data reporting bias, were evaluated using the EMERGE guideline. The review protocol was registered in the PROSPERO database (ID CRD42023441161). Out of the 5911 potential hits, 19 articles, comprising 15 research studies, were identified. These studies enrolled 4163 patients (median 72.1 years; 57.9% males), usually chronically treated with DOACs for atrial fibrillation. EMA was measured in 3451 patients by seven different devices from eight manufacturers; the median population tracked with electronic monitoring was 56 patients over 5 months per study. Observational studies resulted in 88.6% and interventional studies resulted in 92.5% of EMA to DOACs, mostly monitoring regimen and taking adherence. Two studies reported high-quality adherence data, whereas 11 reported low-quality adherence data. The item described in the EMERGE guideline as affecting adherence by measurement method, as appropriate, has rarely been addressed. This review broadens the understanding of the overall high EMA to DOACs reported across various study populations and designs. Furthermore, due to the identified gaps in current literature, it highlights the pressing need for standardized methodologies and improved adherence reporting. This study was supported by the GAUK 328322 and SVV 220665.Keywords: anticoagulants, atrial fibrillation, bias, electronics, implementation, medication adherence