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. 2023 Mar 21;7(1):BJGPO.2022.0179.
doi: 10.3399/BJGPO.2022.0179. Print 2023 Mar.

Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands

Catharina Cm Kager  1 , Maaike Horsselenberg  2 , Joke C Korevaar  2 , Cordula Wagner  2   3 , Karin Hek  2
Affiliations

Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands

Catharina Cm Kager et al. BJGP Open. .

Abstract

Background: In the Dutch atrial fibrillation (AF) guideline for GPs, vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) are seen as equivalent, while in cardiology there is a preference for DOACs.

Aim: To describe the pattern of oral anticoagulant (OAC) prescribing for AF by GPs and assess whether GPs proactively convert between VKAs and DOACs in patients with AF.

Design & setting: Observational study using routine practice data from 214 general practices, from 2017 until 2019.

Method: Patients aged ≥60 years diagnosed with AF, who had been prescribed OACs by their GPs in 2018 were included. A distinction was made between starters, who were participants who did not use OACs in 2017, and prevalent users. It was observed and recorded whether patients switched between VKAs and DOACs.

Results: A total of 12 516 patients with AF were included. Four hundred and seventy-six patients (4%) started OACs in 2018; 12 040 patients were prevalent OAC users. When GPs started patients on OACs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used VKAs (60%). GPs switched between OACs for 1% of starters and 0.6% of prevalent users in 2018 and 2019.

Conclusion: Dutch GPs predominantly start with DOACs in newly diagnosed patients with AF. Prevalent patients predominantly use VKAs and switching from a DOAC to a VKA is unusual. Consequently, the number of patients using VKAs will decline in the upcoming years. This trend raises questions about the future of organising frequent international normalised ratio (INR) checks for VKA users.

Keywords: anticoagulants; atrial fibrillation; direct-acting oral anticoagulant; general practice; prescribing pattern; primary healthcare; vitamin K antagonist.

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Conflict of interest statement

The authors declare that no competing interests exist.

Figures

Figure 1.
Figure 1.. Patients who were newly diagnosed with atrial fibrillation (AF) in 2018 and started a vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC); prescribed by their GP and followed for 1 year to assess switching rate
Figure 2.
Figure 2.. Prevalent patients with atrial fibrillation (AF) using oral anticoagulant (OAC) in 2018. DOAC = direct oral anticoagulant. VKA = vitamin K antagonist.
See this image and copyright information in PMC

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