Cited by 91Atrial Fibrillation Management and OutcomesVenous Thromboembolism Diagnosis and ManagementData-Driven Disease Surveillance

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

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Lippi, Giuseppe, Mattiuzzi, Camilla, Cervellin, Gianfranco, Favaloro, Emmanuel J.·2017·Annals of Translational Medicine

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 1st, 2004) to present time (June 1st, 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.

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  • Lead-in anticoagulation with heparin products adds complexity to the treatment regimen and is one reason why dabigatran or edoxaban is less often prescribed than apixaban and rivaroxaban.

    “Lead-in anticoagulation with heparin products adds complexity to the treatment regimen and is 1 reason why dabigatran or edoxaban is less often prescribed than apixaban and rivaroxaban. 2”

    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 [2]

    The discussion reports a recent decrease in dabigatran use alongside increased prescribing of factor Xa inhibitors, and the sales table lists lower 2015 sales for dabigatran and edoxaban than for apixaban and rivaroxaban. But the paper does not say that dabigatran or edoxaban requires heparin lead-in treatment, or that regimen complexity explains prescribing differences (discussion and Conclusions table; page not provided). (LLM, conf=0.82)

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1 of the 28 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Renda G, Patti G, Sangiuolo R, et al. Management of thromboembolic risk in patients with atrial fibrillation in Italy: follow-up data from the PREFER in AF European Registry. G Ital Cardiol (Rome) 2016;17:922-31.

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Authors
Lippi, G., Mattiuzzi, C., Cervellin, G., & Favaloro, E. J.
Affiliations
  • University of Verona (IT)
  • Provincia Autonoma di Trento (IT)
  • University of Parma (IT)
  • Westmead Hospital (AU)
Corresponding author
Lippi, Giuseppe
Venue
Annals of Translational Medicine
Published
2017-08
Volume
5
Issue
16
Pages
322-322
ISSN
  • 2305-5839 (ISSN-L)
  • 2305-5847
OpenAlex
W2739421744
Cited by
91
References
28
Citations by year
2026: 3 · 2025: 5 · 2024: 10 · 2023: 10 · 2022: 10 · 2021: 10 · 2020: 16 · 2019: 14 · 2018: 13
FWCI
9.10
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Annals of Translational Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • Charles Sturt University Research Output (CRO) (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
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 › Data-Driven Disease Surveillance
Keywords
direct oral anticoagulants, drug diffusion, Google Trends, web search trends, warfarin, heparin, fondaparinux, dabigatran, rivaroxaban, apixaban, edoxaban, anticoagulant prescribing, North America, Europe, Australia, South America, Asia

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