What is the clinical evidence from this study?

Study design: Cohort. Population: Venous thromboembolism (n=19578). Intervention: NOACs (rivaroxaban, apixaban, dabigatran) vs. Vitamin K antagonists (VKA). Primary outcome: Proportion of patients initiated on rivaroxaban vs VKA by September 2016 (p=<0.001).

June 7, 2017Open Access

Temporal trends in initiation of VKA, rivaroxaban, apixaban and dabigatran for the treatment of venous thromboembolism - A Danish nationwide cohort study

Q: What are the key findings of this study?

Initiation of rivaroxaban and apixaban for venous thromboembolism increased significantly over time, reaching 70% and 16% respectively by September 2016, while VKA initiation decreased to 12%.

CSCaroline Sindet‐PedersenHerlev Hospital JPJannik Langtved PallisgaardElectrophysiology LSLaila StærkAmager Hospital

Key Result

Initiation of rivaroxaban and apixaban for venous thromboembolism increased significantly over time, reaching 70% and 16% respectively by September 2016, while VKA initiation decreased to 12%.

Study Design

Type

Cohort (n=19,578)

Structured PICO

Population

19,578 patients aged 15 to 100 years with venous thromboembolism initiating oral anticoagulation therapy in Denmark between 2012 and 2016.

Exposure

Non-vitamin K antagonist oral anticoagulants (NOACs: rivaroxaban, apixaban, dabigatran)

Comparator

Vitamin K antagonists (VKA)

Outcome

Temporal trends in initiation of NOACs versus VKA

The initiation of NOACs, particularly rivaroxaban and apixaban, has significantly increased over time for VTE treatment in Denmark, largely replacing VKAs except in patients with specific comorbidities.

Main Result

Absolute Event Rate: 70% vs 12%

p-value: p=<0.001

Limitations

Lack of information on socioeconomic or sociodemographic status
Lack of important clinical variables such as INR, BMI, smoking status, hepatic status, kidney function, and blood pressure
Edoxaban was not included as it was approved subsequent to the study period
Uncertain generalizability to other countries due to the Danish reimbursement system

Abstract

Danish nationwide registries were used to investigate temporal trends in initiation of rivaroxaban or apixaban or dabigatran versus vitamin K antagonists (VKA) in patients with venous thromboembolism (VTE). Patients treated with one of the NOACs (rivaroxaban, dabigatran, apixaban) or VKA were identified between February 2012 and September 2016. A total of 19,578 patients were included of which 10,844 (55.4%) were treated with VKA and 8,734 (44.6%) were treated with NOACs (rivaroxaban 7,572, apixaban 1,066, and dabigatran 96). Temporal trends showed a decrease in the initiation of VKA (p-value for decreasing trend, p < 0001) and an increase in the initiation of rivaroxaban and apixaban (p-value for increasing trend, p < 0001). By September 2016, 12%, 70%, 16%, and 2% of patients with VTE were initiated on VKA, rivaroxaban, apixaban, and dabigatran. Patients with previous VTE, chronic kidney disease, liver disease, cancer, and thrombophilia were more likely to be initiated on VKA compared with one of the NOACs. In conclusion the initiation of rivaroxaban and apixaban is increasing significantly over time in patients with VTE. Patients with previous VTE, chronic kidney disease, liver disease, cancer, and thrombophilia were more likely to be initiated on VKA compared with rivaroxaban or apixaban.

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