Key result
Dutch general practitioners predominantly prescribed direct oral anticoagulants (88%) to newly diagnosed patients with atrial fibrillation, while prevalent users mostly remained on vitamin K antagonists (60%).
Why the study?
Dutch GP guidelines view VKAs and DOACs as equivalent while cardiology guidelines prefer DOACs, leaving GP prescribing and switching patterns unclear.
What is the pattern of oral anticoagulant prescribing and switching for atrial fibrillation by general practitioners in The Netherlands?
Observational (n=12,516)
Yes
What is the pattern of oral anticoagulant prescribing and switching for atrial fibrillation by general practitioners in The Netherlands?
Dutch general practitioners predominantly initiate DOACs for new atrial fibrillation patients but rarely switch prevalent VKA users to DOACs, indicating a gradual future decline in VKA use.
BACKGROUND: In the Dutch atrial fibrillation (AF) guideline for GPs, vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) are seen as equivalent, while in cardiology there is a preference for DOACs. AIM: To describe the pattern of oral anticoagulant (OAC) prescribing for AF by GPs and assess whether GPs proactively convert between VKAs and DOACs in patients with AF. DESIGN & SETTING: Observational study using routine practice data from 214 general practices, from 2017 until 2019. METHOD: Patients aged ≥60 years diagnosed with AF, who had been prescribed OACs by their GPs in 2018 were included. A distinction was made between starters, who were participants who did not use OACs in 2017, and prevalent users. It was observed and recorded whether patients switched between VKAs and DOACs. RESULTS: A total of 12 516 patients with AF were included. Four hundred and seventy-six patients (4%) started OACs in 2018; 12 040 patients were prevalent OAC users. When GPs started patients on OACs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used VKAs (60%). GPs switched between OACs for 1% of starters and 0.6% of prevalent users in 2018 and 2019. CONCLUSION: Dutch GPs predominantly start with DOACs in newly diagnosed patients with AF. Prevalent patients predominantly use VKAs and switching from a DOAC to a VKA is unusual. Consequently, the number of patients using VKAs will decline in the upcoming years. This trend raises questions about the future of organising frequent international normalised ratio (INR) checks for VKA users.
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Kager et al. (2023) conducted an observational in Atrial fibrillation (n=12,516). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Proportion of DOACs prescribed to patients starting oral anticoagulants. Dutch general practitioners predominantly prescribed direct oral anticoagulants (88%) to newly diagnosed patients with atrial fibrillation, while prevalent users mostly remained on vitamin K antagonists (60%).
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