In a joint document to which Lusa had access to, the PCS and the Faculty of Medicine of the University of Lisbon (FMUL) consider that these medicines should be prescribed in a renewable prescription because "their indications include diseases that require prolonged treatment".

They explained that the initial indication of these drugs was "the primary prevention of venous thromboembolism in adults undergoing total elective hip or knee arthroplasty" and that the prophylaxis period was limited to a maximum of two (knee) and five (hip) weeks, but the indications widened and four of them began to be reimbursed for "prevention of thromboembolic events in patients with non-valvular atrial fibrillation".

"In this indication, unlike the initial indications, it is recommended to maintain oral anticoagulant therapy indefinitely", they stress, supporting the idea of the need for renewable prescription.

The type of prescription available for prescribing these drugs is confined to a month-long non-renewable prescription, experts add, who say that with recent indications "this type of prescription makes prescribing these drugs more bureaucratic, requiring a greater number of medical acts to prescribe more prescriptions in a short period of time, also compromising access to the drug by patients."

A lower therapeutic adherence promoted by the prescription type currently available for direct oral anticoagulants "increases the likelihood of thrombus formation, being in this context a documented risk factor for stroke and mortality, compromising the prognosis of patients with atrial fibrillation," they add.

The two entities recall that the prescription of oral anticoagulants, particularly these, has increased in recent years and that atrial fibrillation "is probably the most prevalent pathology with indication for oral anticoagulation".

Both PCS and FMUL stress that this direct oral anticoagulants "showed a significant reduction in the relative risk of mortality, and stroke or systemic embolism", as well as being shown to be "safer with regard to the risk of major bleeding, demonstrating a significant reduction in the risk of these events, in particular the risk of intracranial haemorrhage, with relative risk reduction was about 50 percent compared to vitamin K antagonists".

In Portugal, in recent years, there has been a decrease in mortality from strokes and, according to the two entities, it was recognized by the 2017 report of the National Program for Brain-Cardiovascular Diseases that this improvement in results was associated with an increase in indications for the prescription of direct oral anticoagulants for atrial fibrillation.