What is the clinical evidence from this study?

Study design: Observational. Population: Nonvalvular Atrial Fibrillation. Intervention: Oral anticoagulants (DOACs and VKAs). Primary outcome: Time trends in the initiation of direct oral anticoagulants versus vitamin K antagonists.

What does this research mean for the field?

Direct oral anticoagulant (DOAC) prescriptions for atrial fibrillation increased from 2010 to 2017, accounting for 86.1%-93.1% of new starts by 2017, with apixaban being the most common. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To characterize and compare international temporal trends in the prescribing of vitamin K antagonists and individual direct oral anticoagulants, as well as treatment switching and continuation, among patients with atrial fibrillation.

January 1, 2022International Journal of Clinical PracticeOpen Access

Time Trends and Treatment Pathways in Prescribing Individual Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation: An Observational Study of More than Three Million Patients from Europe and the United States

View Full Paper

Ask AI

Bookmark

Key result

DOAC initiation for AF surged to ~90% across the US and Europe by 2017.

Why the study?

Data directly comparing trends in the use of different oral anticoagulants among patients with atrial fibrillation from different countries were limited.

Key Points

To characterize and compare international temporal trends in the prescribing of vitamin K antagonists and individual direct oral anticoagulants, as well as treatment switching and continuation, among patients with atrial fibrillation.
Retrospective network cohort study utilizing nine electronic health record or claims databases converted to the Observational Medical Outcomes Partnership Common Data Model across the United States, Belgium, France, Germany, and the United Kingdom.
In 2010, between 87.5% and 99.8% of patients initiated therapy on a vitamin K antagonist, but by 2017, direct oral anticoagulants comprised the majority of initial therapies: 87.0% (US), 88.3% (Belgium), 93.1% (France), 88.4% (Germany), and 86.1%–86.7% (UK).
Apixaban became the most common starting drug by 2017 (50.2%–57.8% in the US, 31.4% in Belgium, 45.9% in France, 39.5% in Germany, and 49.8%–50.5% in the UK), followed by rivaroxaban (24.8%–32.5% in the US, 25.7% in Belgium, 38.4% in France, 24.9% in Germany, and 30.2%–31.2% in the UK).
Most patients maintained their initial medication over a two-year follow-up, while discontinuation by 2017 among 2010 initiators ranged from 15.4%–16.1% in the UK to 32.9%–54.2% in the US.

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Population

Over three million adults with atrial fibrillation newly initiated on an oral anticoagulant across the US and Europe, followed to assess prescribing trends and treatment pathways between 2010 and 2017.

Exposure

First prescription of an oral anticoagulant (vitamin K antagonist or direct oral anticoagulant including dabigatran, rivaroxaban, apixaban, or edoxaban)

Outcome

Time trends in use, continuation, and switching of oral anticoagulants

Between 2010 and 2017, there was a significant global shift from VKAs to DOACs for stroke prevention in atrial fibrillation, with apixaban becoming the most prescribed OAC by 2017.

Limitations

Findings from claims databases are limited to the insured populations from which the samples were drawn.
Sunburst plots provide information on OAC switching but do not indicate the exact switching date.
Sample sizes were smaller for Belgium and France, potentially affecting accuracy compared to larger datasets.
Lack of adjusted analyses to determine independent driving factors for OAC discontinuation.
Findings from claims databases are limited to the wider insured populations from which the samples were drawn
Sunburst plots provide information on OAC switching but do not indicate the exact switching date
Sample sizes were at least a magnitude smaller for Belgium and France, potentially affecting accuracy compared to larger datasets

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Observed shift to DOACs in AF; extends real-world adoption data but leaves open effects on outcomes and persistence.

Cite This Study

Vora et al. (2022) conducted an observational in Nonvalvular Atrial Fibrillation. Oral anticoagulants (DOACs and VKAs) was evaluated on Time trends in the initiation of direct oral anticoagulants versus vitamin K antagonists. From 2010 to 2017, the proportion of patients with atrial fibrillation initiated on a direct oral anticoagulant increased significantly, reaching 83.7% to 93.1% across the US and Europe by 2017.

synapsesocial.com/papers/6a18d997c9d74cf65281fb84 https://doi.org/10.1155/2022/6707985

Topics

Atrial fibrillation Anticoagulation in AF Persistent AF management

View Full Paper

Ask AI

Bookmark

Time Trends and Treatment Pathways in Prescribing Individual Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation: An Observational Study of More than Three Million Patients from Europe and the United States

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Time Trends and Treatment Pathways in Prescribing Individual Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation: An Observational Study of More than Three Million Patients from Europe and the United States

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider