Increased use of oral anticoagulants in patients with atrial fibrillation: temporal trends from 2005 to 2015 in Denmark

Gadsbøll, Kasper; Stærk, Laila; Fosbøl, Emil Loldrup; Sindet-Pedersen, Caroline; Gundlund, Anna; Lip, Gregory Y.H.; Gislason, Gunnar; Olesen, Jonas Bjerring

doi:10.1093/eurheartj/ehw658

Cited by 109 publications

(149 citation statements)

References 27 publications

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“…Although assessment of the appropriateness of dosing was not possible in the present study, this may indicate underdosing with edoxaban in some patients. Physicians withholding or underdosing anticoagulation in order to avoid bleeding have previously been reported in real‐life studies on patients treated with DOACs. Importantly, low‐dose edoxaban was inferior to warfarin with regards to prevention of ischaemic stroke in the ENGAGE AF trial …”

Section: Discussionmentioning

confidence: 99%

Use of direct oral anticoagulants in the first year after market entry of edoxaban: A Danish nationwide drug utilization study

Pottegård

Grove

Hellfritzsch

2017

Pharmacoepidemiology and Drug

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Section: Discussionmentioning

confidence: 99%

Use of direct oral anticoagulants in the first year after market entry of edoxaban: A Danish nationwide drug utilization study

Pottegård

Grove

Hellfritzsch

2017

Pharmacoepidemiology and Drug

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“…Although some very recent national studies support the common perception that prescription of these cuttingedge therapeutics may be constantly increasing worldwide, mostly as suitable replacement of historical anticoagulants (8)(9)(10)(11)(12)(13), no definitive statistics have been published regarding their real diffusion into different countries, nor is reliable data available on the general interest of patients and physicians about their usage.…”

Section: Introductionmentioning

confidence: 99%

Direct oral anticoagulants: analysis of worldwide use and popularity using Google Trends

Lippi¹,

Mattiuzzi²,

Cervellin³

et al. 2017

Ann. Transl. Med.

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Background: Four direct oral anticoagulants (DOACs) have been approved for clinical use by many medicines regulatory agencies around the world. Due to increasing use of these drugs in routine practice, we planned an original study to investigate their worldwide diffusion using a popular Web-search engine.Methods: Two electronic searches were performed using Google Trends, the former using the keywords "warfarin" AND "heparin" AND "fondaparinux", and the latter using the keywords "warfarin" AND "dabigatran" AND "rivaroxaban" AND "apixaban" AND "edoxaban", both using the search criterion Results: The median Google Trends score of warfarin (i.e., 86) was consistently higher than that of heparin (54; P<0.001), fondaparinux (6; P<0.001), dabigatran (11; P<0.001), rivaroxaban (5; P<0.001), apixaban (1; P<0.001) and edoxaban (1; P<0.001). Specific analysis of the trends shows that the score of warfarin exhibits a highly significant decrease over time (r=−0.40; P<0.001), whilst that of heparin has remained virtually unchanged (r=0.12; P=0.127), and that of fondaparinux has marginally increased (r=0.16; P=0.038).As regards DOACs, the scores of these drugs significantly increased during the search period (dabigatran, r=0.79; rivaroxaban, r=0.99; apixaban, r=0.98; edoxaban, r=0.78; all P<0.001). When the analysis was limited to the past five years, the dabigatran score significantly decreased (r=−0.57; P<0.001), whereas that of the other DOACs exhibited an even sharper increase. Most Google searches for DOACs were performed in North America, central-eastern Europe and Australia. Conclusions:The results of our analysis suggest that the popularity of DOACs is constantly increasing around the world, whereas that of warfarin has exhibited a constant and inexorable decline.

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“…In other settings, the introduction of DOACs was associated with an increase in the OAC initiation rate by 25%-75%. 28,44 In our study, despite OAC initiation rates among Veterans without Medicare Part D coverage with AF increasing over time, the impact of DOACs has been lower for patients enrolled in Part D. This trend may be due to the providers' reluctance to provide DOACs with incomplete information about patients receiving care from multiple systems, given the DOACs' potential for overprescribing. 17 The overall lower rates of initiation among dual patients may be due to coordination of care issues in which providers in each system assume AF is being managed by providers in the other system.…”

Section: A Review By Ogilvie Et Al 7 Covering Us and International Pamentioning

confidence: 65%

“…We also identified an extended cohort of patients in which we required that patients only have one AF diagnosis based on VHA data coded during an outpatient encounter. This definition was consistent with other previous studies which assumed one AF diagnosis was sufficient to determine persistent AF . We then applied the same exclusions detailed above for the main sample.…”

Section: Methodsmentioning

confidence: 79%

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Guideline‐concordant initiation of oral anticoagulant therapy for stroke prevention in older veterans with atrial fibrillation eligible for Medicare Part D

Done

Roy

Yuan

et al. 2018

Health Services Research

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Objective To characterize the rate of guideline‐concordant initiation of oral anticoagulation (OAC) among elderly Veterans with atrial fibrillation (AF) and high stroke risk. Data Sources/Study Setting Veterans Health Administration (VHA) Corporate Data Warehouse (CDW) linked with Medicare claims 2011‐2015. Study Design We identified 6619 elderly, high stroke‐risk patients with a new episode of AF initially diagnosed in the VHA during fiscal years 2012‐2015. We used logistic regression to estimate marginal effects of associations between patient characteristics and OAC initiation within 90 days of the first AF episode. Data Extraction Methods We identified OACs using generic drug names. We calculated comorbidities and risk scores using diagnosis codes from 1 year of baseline data. Principal Findings Overall, 66.5% of Medicare‐eligible Veterans with AF at high risk of stroke initiated an OAC within 90 days. We found lower initiation rates for patients enrolled in Medicare Part D and those ineligible for drug co‐payment subsidies. OAC initiation rates increased during the study among VHA‐reliant patients but not among dual VHA‐Part D enrollees. Conclusions One‐third of elderly Veterans at risk of stroke are not receiving recommended therapy. Increased coordination between Medicare and VHA providers may lead to improvements in anticoagulation quality and stroke prevention.

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Increased use of oral anticoagulants in patients with atrial fibrillation: temporal trends from 2005 to 2015 in Denmark

Abstract: Since 2010, more incident AF patients in Denmark were initiated on OAC therapy with predominant NOAC prescription. The increase was pronounced among females, among patients at high risk of stroke, and among older patients.

Cited by 109 publications

References 27 publications

Use of direct oral anticoagulants in the first year after market entry of edoxaban: A Danish nationwide drug utilization study

Use of direct oral anticoagulants in the first year after market entry of edoxaban: A Danish nationwide drug utilization study

Direct oral anticoagulants: analysis of worldwide use and popularity using Google Trends

Guideline‐concordant initiation of oral anticoagulant therapy for stroke prevention in older veterans with atrial fibrillation eligible for Medicare Part D

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