Medication Adherence and Antithrombotic Therapy Outcomes: Insights From a Post Hoc Analysis of the AFIRE Trial (JACC Asia March 2026)-Article: Medication Adherence and Antithrombotic Therapy Outcomes: Insights From a Post-hoc Analysis of the AFIRE Trial

Article: Medication Adherence and Antithrombotic Therapy Outcomes: Insights From a Post-hoc Analysis of the AFIRE Trial

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This post hoc analysis of the AFIRE trial examined whether medication adherence affected outcomes of rivaroxaban monotherapy versus rivaroxaban plus an antiplatelet agent in patients with atrial fibrillation and stable coronary artery disease. Adherence was assessed by self-report questionnaires at 6 months and at study end; 2,120 patients were analyzed, and 94.9% were classified as adherent.<br /><br />Among adherent patients, rivaroxaban monotherapy was associated with significantly better efficacy outcomes than combination therapy, with fewer composite ischemic/death events (adjusted HR 0.72) and less major bleeding (adjusted HR 0.63). In contrast, among the small nonadherent group, there were no significant differences between treatment strategies for either efficacy or safety. There was no statistically significant interaction between adherence status and randomized treatment.<br /><br />When comparing adherent with nonadherent patients, adherence tended to be associated with better overall efficacy outcomes, and this was particularly clear in patients with a history of angina pectoris, a clinically higher-risk subgroup. In that subgroup, adherent patients had significantly better efficacy outcomes than nonadherent patients, while bleeding outcomes were similar.<br /><br />Landmark analyses and a second adherence questionnaire showed similar patterns, supporting the robustness of the findings. The study suggests that the benefits of rivaroxaban monotherapy seen in AFIRE are most apparent when patients take medication as prescribed. The authors conclude that high adherence is crucial for maximizing the therapeutic benefit of rivaroxaban monotherapy in this population.

Meta Tag

Concept Medication Adherence

Concept Medication Nonadherence

Concept Rivaroxaban

Concept Atrial Fibrillation

Concept Clinical Outcome

Keywords

AFIRE trial

rivaroxaban monotherapy

atrial fibrillation

stable coronary artery disease

medication adherence

antiplatelet therapy

major bleeding

ischemic events

landmark analysis

angina pectoris

Medication Adherence

Medication Nonadherence

Rivaroxaban

Atrial Fibrillation

Clinical Outcome