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Comparative Study
. 2017 Sep;83(9):2096-2106.
doi: 10.1111/bcp.13299. Epub 2017 May 4.

Trends in the prescription of novel oral anticoagulants in UK primary care

Simone Y Loo  1   2 , Sophie Dell'Aniello  2 , Laetitia Huiart  3 , Christel Renoux  1   2   4
Affiliations
Comparative Study

Trends in the prescription of novel oral anticoagulants in UK primary care

Simone Y Loo et al. Br J Clin Pharmacol. 2017 Sep.

Abstract

Aims: Novel oral anticoagulants (NOACs) are alternatives to vitamin-K antagonists (VKAs) for the prevention of thromboembolism. It is unclear how NOACs have been adopted in the UK since first introduced in 2008. The present study was conducted to describe the trends in the prescription of NOACs in the UK, including dabigatran, rivaroxaban and apixaban.

Methods: Using the UK's Clinical Practice Research Datalink, the rates of new use of NOACs and VKAs from 2009 to 2015 were calculated using Poisson regression. Patient characteristics associated with NOAC initiation were identified using multivariate logistic regression.

Results: The overall rate of oral anticoagulant initiation increased by 58% over the study period [rate ratio (RR) 1.58; 95% confidence interval (CI) 1.23, 2.03], even as the rate of new VKA use decreased by 31% (RR 0.69; 95% CI 0.52, 0.93). By contrast, the rate of initiation of NOAC increased, particularly from 2012 onwards, with a 17-fold increase from 2012 to 2015 (RR 17.68; 95% CI 12.16, 25.71). In 2015, NOACs accounted for 56.5% of oral anticoagulant prescriptions, with rivaroxaban prescribed most frequently, followed by apixaban and then dabigatran. Compared to VKAs, new NOAC users were less likely to have congestive heart failure, coronary artery disease and peripheral vascular disease, and more likely to have a history of ischaemic stroke.

Conclusions: In the UK, the rate of initiation of NOACs has increased substantially since 2009, and these agents have now surpassed VKAs as the anticoagulant of choice. Moreover, the characteristics of patients initiated on NOACs have changed over time, and this should be accounted for in future studies comparing NOACs and VKAs.

Keywords: atrial fibrillation; oral anticoagulants; pharmacoepidemiology; prescription patterns; venous thromboembolism.

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Figures

Figure 1
Figure 1
Rates of new use of oral anticoagulants (OAC) in the UK Clinical Practice Research Datalink, from 2009 to 2015. NOAC, novel oral anticoagulants; VKA, vitamin K antagonists
Figure 2
Figure 2
Rates of new use of individual novel oral anticoagulants (NOAC) in the UK Clinical Practice Research Datalink, from 2009 to 2015
Figure 3
Figure 3
Age‐stratified rates of new use of novel oral anticoagulants (A) and vitamin K antagonists (B) in the UK Clinical Practice Research Datalink, from 2009 to 2015
Figure 4
Figure 4
Rates of new use of oral anticoagulants (OAC) with an indication for atrial fibrillation (A) and venous thromboembolism (B) in the UK Clinical Practice Research Datalink, from 2009 to 2015. NOAC, novel oral anticoagulants; VKA, vitamin K antagonists
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References

    1. Southan C, Sharman JL, Benson HE, Faccenda E, Pawson AJ, Alexander SPH, et al. The IUPHAR/BPS Guide to PHARMACOLOGY in 2016: towards curated quantitative interactions between 1300 protein targets and 6000 ligands. Nucleic Acids Res 2016; 44: D1054–D1068. - PMC - PubMed
    1. Hart RG, Pearce LA, Aguilar MI. Meta‐analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146: 857–867. - PubMed
    1. Ridker PM, Goldhaber SZ, Danielson E, Rosenberg Y, Eby CS, Deitcher SR, et al., PREVENT Investigators . Long‐term, low‐intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348: 1425–1434. - PubMed
    1. Hylek EM, Evans‐Molina C, Shea C, Henault LE, Regan S. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 2007; 115: 2689–2696. - PubMed
    1. Shameem R, Ansell J. Disadvantages of VKA and requirements for novel anticoagulants. Best Pract Res Clin Haematol 2013; 26: 103–114. - PubMed

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