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. 2015 Dec;128(12):1300-5.e2.
doi: 10.1016/j.amjmed.2015.05.044. Epub 2015 Jul 2.

National Trends in Ambulatory Oral Anticoagulant Use

Geoffrey D Barnes  1 , Eleanor Lucas  2 , G Caleb Alexander  2 , Zachary D Goldberger  3
Affiliations

National Trends in Ambulatory Oral Anticoagulant Use

Geoffrey D Barnes et al. Am J Med. 2015 Dec.

Abstract

Background: Four direct oral anticoagulants (DOACs) have been brought to market for the treatment of nonvalvular atrial fibrillation and venous thromboembolism. Many forces, including numerous positive trial results, emerging safety concerns, marketing, and promotion, may shape DOAC adoption by providers. However, relatively little is known regarding their ambulatory utilization compared with warfarin, as well as the degree to which they have decreased under-treatment of atrial fibrillation.

Methods: We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of outpatient office visits, to estimate the use of warfarin and DOACs between 2009 and 2014.

Results: Overall, visits with anticoagulation use increased from 2.05 (95% confidence interval [CI], 1.82-2.27) to 2.83 (95% CI, 2.49-3.17) million (M) quarterly visits (P < .001). Of these, DOAC use has grown to 4.21M (95% CI, 3.63M-4.79M; 38.2% of total) treatment visits in 2014 since their introduction in 2010. Use of all oral anticoagulants in treatment visits for atrial fibrillation has increased from 0.88M (95% CI, 0.74M-1.02M) to 1.72M (95% CI, 1.47M-1.97M; P < .001), with similar DOAC and warfarin use in 2014. Atrial fibrillation visits with anticoagulant use increased from 51.9% (95% CI, 50.4%-53.8%) to 66.9% (95% CI, 65.0%-69.3%) between 2009 and 2014 (P < .001). In 2014, rivaroxaban was the most commonly prescribed DOAC for atrial fibrillation (47.9% of office visits), followed by apixaban (26.5%) and dabigatran (25.5%).

Conclusions: Direct oral anticoagulants have been adopted rapidly, matching the use of warfarin, and are associated with increased use of oral anticoagulation for patients with atrial fibrillation.

Keywords: Anticoagulants; Atrial Fibrillation; Venous Thromboembolism; Warfarin.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Barnes has received research funding from Bristol-Myers-Squibb/Pfizer and Blue Cross-Blue Shield of Michigan as well as consulting fees from Portola Pharmaceutical, none of which supported this analysis. Dr. Alexander is Chair of the FDA's Peripheral and Central Nervous System Advisory Committee, serves as a paid consultant to IMS Health, and serves on an IMS Health scientific advisory board. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies.

Figures

Figure 1
Figure 1. Quarterly Visits with Oral Anticoagulant Use
Quarterly use of oral anticoagulant during office visits. DOAC – direct oral anticoagulant Source: IMS Health National Disease and Therapeutic Index, 2009-2014
Figure 2
Figure 2. Quarterly Visits for Atrial Fibrillation by Anticoagulant Type
Quarterly office visits for atrial fibrillation by anticoagulant type. DOAC – direct oral anticoagulant Source: IMS Health National Disease and Therapeutic Index, 2009-2014
Figure 3
Figure 3. Quarterly Atrial Fibrillation Visits and Percent with Anticoagulation
The percent of quarterly office visits for atrial fibrillation with anticoagulant use. Source: IMS Health National Disease and Therapeutic Index, 2009-2014
See this image and copyright information in PMC

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