Cited by 598Atrial Fibrillation Management and OutcomesVenous Thromboembolism Diagnosis and ManagementAcute Ischemic Stroke Management

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National Trends in Ambulatory Oral Anticoagulant Use

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Barnes, Geoffrey D., Lucas, Eleanor, Alexander, G. Caleb, Goldberger, Zachary D.·2015·The American Journal of Medicine

DOI 10.1016/j.amjmed.2015.05.044PMC PMC4658248

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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.

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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.
ORCID: Barnes, Geoffrey D.
Lucas, Eleanor
Alexander, G. Caleb
Goldberger, Zachary 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)
DOI: 10.1016/j.amjmed.2015.05.044
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
FWCI: 42.18
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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 › Clinical Neurology › 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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