Worldwide trends in oral anticoagulant use in patients with atrial fibrillation from 2010 to 2018: a systematic review and meta-analysis

Abstract

Aims Non-vitamin K antagonist oral anticoagulants (NOACs) are effective and safe alternatives compared with vitamin K antagonists (VKAs) for thromboembolic prevention in atrial fibrillation (AF), while antiplatelets are no longer recommended. However, to which extent NOAC introduction and guideline updates have increased OAC use in AF, is unclear. Therefore, worldwide trends in real-life prescribing of OACs, NOACs, VKAs, and antiplatelet monotherapy in AF patients were investigated. Methods and results Using PubMed and Embase, observational nationwide cohort studies on annual prevalent and/or incident OAC use in non-selected AF patients since 2010 were included. A meta-analysis of single proportions was performed. Twenty-one studies were included assessing prevalent and incident use among 9 758 637 and 197 483 OAC-eligible AF patients, respectively. Worldwide prevalence and incidence of OAC users increased from 0.42 [95% confidence interval (CI) 0.22–0.65] and 0.43 (95% CI 0.37–0.49) in 2010 to 0.78 (95% CI 0.77–0.78) and 0.75 (95% CI 0.74–0.76) in 2018, respectively. Prevalent and incident NOAC users increased globally from 0 in 2010 to 0.45 (95% CI 0.45–0.46) and 0.68 (95% CI 0.67–0.69) in 2018, respectively, whereas prevalent and incident VKA use decreased from 0.42 (95% CI 0.22–0.65) and 0.42 (95% CI 0.36–0.49) in 2010 to 0.32 (95% CI 0.32–0.32) and 0.06 (95% CI 0.06–0.07) in 2018, respectively. Prevalent antiplatelet monotherapy use decreased from 0.37 (95% CI 0.32–0.42) in 2010 to 0.09 (95% CI 0.09–0.10) in 2018. Conclusion The proportion of OAC users worldwide almost doubled following NOAC introduction. As one-quarter of OAC-eligible AF subjects were not anticoagulated and 9% were only treated with antiplatelets in 2018, there is still room for improvement.

Adherence and persistence to oral anticoagulants in patients with atrial fibrillation: A Belgian nationwide cohort study

“…Since 2010, non-vitamin K antagonist oral anticoagulants (NOACs) have emerged as effective and safe alternatives to VKAs ( 1 ). Following their approval, worldwide anticoagulant use has almost doubled in the last decade, with NOACs being more initiated than VKAs in newly-diagnosed AF patients since 2014 ( 2 ). In Belgium, NOAC uptake was remarkably fast, given the early experience with NOACs thanks to “compassionate use” programs, which allow the use of drugs with an approved European indication before they are commercially available ( 3 , 4 ).…”

Is the Risk of Diabetes Lower in Patients With Atrial Fibrillation Treated With Direct Oral Anticoagulant Compared to Warfarin?

“…Warfarin has a narrow therapeutic range, multiple drug and food interactions, and requires frequent blood monitoring of the international normalized ratio (INR) ( 2 ). Therefore, direct oral anticoagulants (DOACs, sometimes referred to as non-vitamin K antagonist anticoagulants) have been introduced in the clinic, reducing the risk of stroke or systemic embolism and bleeding compared with warfarin among patients with AF ( 3 – 5 ).…”

A call to action for anticoagulation stewardship

“…Tens of millions of patients worldwide use anticoagulant medications to prevent or treat thrombotic conditions, including atrial fibrillation and venous thromboembolism. With the introduction of direct oral anticoagulants (DOACs) as preferred therapy over vitamin K antagonists (eg, warfarin), overall use of anticoagulants has increased markedly 1 . Concurrently, there has also been a rise in anticoagulant‐related adverse drug events (ADEs), including life‐threatening bleeding and thrombotic complications 2,3 .…”

“…With the introduction of direct oral anticoagulants (DOACs) as preferred therapy over vitamin K antagonists (eg, warfarin), overall use of anticoagulants has increased markedly. 1 Concurrently, there has also been a rise in anticoagulant‐related adverse drug events (ADEs), including life‐threatening bleeding and thrombotic complications. 2 , 3 To address this growing health crisis, anticoagulation stewardship programs have been instituted in several health systems.…”