Worldwide prevalence of oral anticoagulant use in atrial fibrillation patients increased from 0.42 (95% CI 0.22-0.65) in 2010 to 0.78 (95% CI 0.77-0.78) in 2018 following NOAC introduction.
Meta-Analysis (n=9,956,120)
Yes
The proportion of OAC users worldwide almost doubled from 2010 to 2018 following the introduction of NOACs, though a significant treatment gap remains with one-quarter of eligible patients not anticoagulated.
Absolute Event Rate: 0.78% vs 0.42%
AIMS: Non-vitamin K antagonist oral anticoagulants (NOACs) are effective and safe alternatives compared with vitamin K antagonists (VKAs) for thromboembolic prevention in atrial fibrillation (AF), while antiplatelets are no longer recommended. However, to which extent NOAC introduction and guideline updates have increased OAC use in AF, is unclear. Therefore, worldwide trends in real-life prescribing of OACs, NOACs, VKAs, and antiplatelet monotherapy in AF patients were investigated. METHODS AND RESULTS: Using PubMed and Embase, observational nationwide cohort studies on annual prevalent and/or incident OAC use in non-selected AF patients since 2010 were included. A meta-analysis of single proportions was performed. Twenty-one studies were included assessing prevalent and incident use among 9 758 637 and 197 483 OAC-eligible AF patients, respectively. Worldwide prevalence and incidence of OAC users increased from 0.42 95% confidence interval (CI) 0.22-0.65 and 0.43 (95% CI 0.37-0.49) in 2010 to 0.78 (95% CI 0.77-0.78) and 0.75 (95% CI 0.74-0.76) in 2018, respectively. Prevalent and incident NOAC users increased globally from 0 in 2010 to 0.45 (95% CI 0.45-0.46) and 0.68 (95% CI 0.67-0.69) in 2018, respectively, whereas prevalent and incident VKA use decreased from 0.42 (95% CI 0.22-0.65) and 0.42 (95% CI 0.36-0.49) in 2010 to 0.32 (95% CI 0.32-0.32) and 0.06 (95% CI 0.06-0.07) in 2018, respectively. Prevalent antiplatelet monotherapy use decreased from 0.37 (95% CI 0.32-0.42) in 2010 to 0.09 (95% CI 0.09-0.10) in 2018. CONCLUSION: The proportion of OAC users worldwide almost doubled following NOAC introduction. As one-quarter of OAC-eligible AF subjects were not anticoagulated and 9% were only treated with antiplatelets in 2018, there is still room for improvement.
Grymonprez et al. (Fri,) conducted a meta-analysis in Atrial fibrillation (n=9,956,120). Oral anticoagulants (NOACs and VKAs) vs. Time trend (2010 vs 2018) was evaluated on Worldwide prevalence of OAC users. Worldwide prevalence of oral anticoagulant use in atrial fibrillation patients increased from 0.42 (95% CI 0.22-0.65) in 2010 to 0.78 (95% CI 0.77-0.78) in 2018 following NOAC introduction.