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

Abstract

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 "prescription drug". No language restriction was applied, and the searches were carried out from the first date available in Google Trends (January 1^st, 2004) to present time (June 1^st, 2017).

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.

Keywords: Anticoagulants; Google Trends; direct oral anticoagulants (DOACs); laboratory.

Figure 1

Evolution of the Google Trends score for warfarin, heparin, fondaparinux, dabigatran, rivaroxaban, apixaban and edoxaban between January 2004 and May 2017.

Figure 2

Evolution of the Google Trends score for warfarin between January 2004 and May 2017. The continuous line represents the Spearman’s correlation between the Google Trends score and the month of the year throughout the search period, whereas the dotted line describes the same correlation over the past 5 years.

Figure 3

Evolution of the Google Trends score for dabigatran, rivaroxaban, apixaban and edoxaban over the past 5 years. The continuous line represents the Spearman’s correlation between the Google Trends score and the month of the year.

Figure 4

Geographical distribution of web searches recorded by Google Trends over the past 5 years. (A) Dabigatran; (B) Rivaroxaban; (C) Apixaban; (D) Edoxaban.

Figure 5

Evolution of the Google Trends score for heparin between January 2007 and December 2009 in US, Australia, Japan and Italy.

Figure 6

Evolution of the worldwide Google Trends score for dabigatran, rivaroxaban, apixaban and edoxaban in the past 5 years.

Figure 7

Evolution of the worldwide Google Trends score for dabigatran, rivaroxaban, apixaban and edoxaban in the past 5 years in US, Australia, Japan and Italy.