National trends in ambulatory oral anticoagulant use
Open accessAbstract
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.
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Apixaban and rivaroxaban are now increasingly used for acute VTE compared with vitamin K antagonists and other DOACs.
“Hence, apixaban and rivaroxaban are now increasingly used for acute VTE compared with VKAs and other DOACs. 3”
From Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world (2019) · cites this paper as [3]
The Discussion (page not provided) says DOAC use rose as warfarin use declined in venous thromboembolism office visits, supporting the trend for rivaroxaban. But it says that DOAC use in those visits was almost exclusively rivaroxaban; the reported rise in apixaban use concerns atrial fibrillation, not acute VTE. The study also does not distinguish acute VTE visits from other VTE visits. (LLM, conf=0.88)
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- Authors
- Barnes, G. D., Lucas, E., Alexander, G. C., & Goldberger, Z. D.
- Affiliations
- University of Michigan (US)
- Johns Hopkins University (US)
- University of Washington (US)
- Corresponding author
- Barnes, Geoffrey D.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 128
- Issue
- 12
- Pages
- 1300-1305.e2
- ISSN
- 0002-9343 (ISSN-L)
- PMC
- PMC4658248
- OpenAlex
- W826970266
- Cited by
- 598
- References
- 41
- Citations by year
- 2026: 11 · 2025: 25 · 2024: 23 · 2023: 38 · 2022: 72 · 2021: 69 · 2020: 87 · 2019: 97 · 2018: 83 · 2017: 61 · 2016: 29 · 2015: 1 · 2014: 1
- FWCI
- 42.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01 HL107345, T32 HL007853-16)
- Portola Pharmaceuticals
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- direct oral anticoagulants, warfarin, atrial fibrillation, venous thromboembolism, outpatient care, rivaroxaban, apixaban, dabigatran, prescribing patterns, drug adoption
- MeSH terms
- Rivaroxaban, Dabigatran, Administration, Oral, Adult, Age Factors, Aged, Ambulatory Care, Anticoagulants, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Pyrazoles, Pyridones, United States, Warfarin, Venous Thromboembolism, Young Adult
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