Background: Over the past decade, direct oral anticoagulants (DOACs) have increasingly replaced warfarin as the preferred agents for multiple indications, with specific agents favored for different patient groups based on evidence of efficacy, safety, and convenience. However, the extent to which DOACs and warfarin are used among patients with chronic diseases such as atrial fibrillation, cancer, chronic kidney disease (CKD), and obesity remains insufficiently characterized. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2009 to March 2020 (n = 55,999) to estimate national trends in the use of oral anticoagulant (OAC) among U.S. adults (≥18 years). All estimates were generated using survey-weighted methods accounting for NHANES’s complex, multistage, stratified cluster design. Results: Over the past decade, the prevalence of DOAC use in the US adult population increased from 0.03% (95% CI: 0.01–0.11%; dabigatran used only) in 2009–2012 to 1.3 % (95% CI:1.1–1.6%) in 2017–March 2020, with apixaban (44.6%) and rivaroxaban (43.1%) being the predominant agents. During the same period, warfarin use decreased from 1.6% (95% CI:1.3–1.9%) to 0.9% (95% CI:0.7–1.2%) ( Figure 1A). Similar increasing trends in overall OAC and DOAC use, accompanied by corresponding declines in warfarin use, were observed across subgroups. Among adults with atrial fibrillation and a CHA2DS2-VA score ≥2, the prevalence of DOAC use increased from 27.6% (95% CI:18.7–36.6%) in 2013–2016 to 53.4% (95% CI:41.3–65.5%) in 2017–March 2020 (Figure 1B). From 2009 to 2020, the prevalence of OAC use among adults with cancer was over threefold higher than among those without cancer (5.7% vs 1.5%; p < 0.001) (Figure 1C). In adults with CKD stages 3–5, DOAC use increased from 0.2% to 11.6%, with apixaban comprising 77.4% of OAC use in stage 4 CKD in 2017–March 2020 (Figure 1D). Across body mass index (BMI) categories, OAC use increased among overweight and obese adults but declined among those with normal or low body weight. In 2017–March 2020, apixaban (0.8%; 95% CI:0.2–3.6%) and rivaroxaban (0.4%; 95% CI:0.1–3.1%) were the most commonly used OACs in underweight individuals (Figure 1E). Conclusions: DOAC use increased between 2009 and March 2020 in the U.S. general adult population and across different subgroups. Apixaban emerged as the predominant DOAC used among individuals with atrial fibrillation, advanced CKD, cancer, and low body weight.
Nguyen et al. (Tue,) studied this question.