Impact of the COVID-19 pandemic on England’s national prescriptions of oral vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs): an interrupted time series analysis (January 2019–February 2021)

Sajidah Alkhameys; Ravina Barrett

doi:10.1080/03007995.2022.2078100

May 18, 2022Current Medical Research and OpinionOpen Access

Impact of the COVID-19 pandemic on England’s national prescriptions of oral vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs): an interrupted time series analysis (January 2019–February 2021)

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Why the study?

The COVID-19 pandemic could increase stroke or bleeding risk due to nonadherence or sub/supra-optimal dosing, prompting investigation into DOAC prescription trends in England during the first wave.

How did the COVID-19 pandemic affect the prescription patterns of DOACs and warfarin in primary care in England?

Structured PICO

How did the COVID-19 pandemic affect the prescription patterns of DOACs and warfarin in primary care in England?

P

Population

Primary care patients in England receiving oral anticoagulants (DOACs or warfarin) between January 2019 and February 2021

I

Intervention

COVID-19 pandemic (cut-off March 2020)

C

Comparator

Pre-pandemic period (January 2019 to February 2020)

O

Outcome

Prescription volume and patterns of DOACs (dabigatran, rivaroxaban, apixaban, edoxaban) and warfarin

The COVID-19 pandemic caused an initial spike in DOAC prescriptions in England, followed by a slowing of the pre-existing upward trend, indicating a potential medical needs gap.

Implication

Pandemic disruptions accelerated DOAC uptake over warfarin in England; leaves open effects on adherence, stroke prevention, and bleeding in community AF patients.

Abstract

Background Direct-acting oral anticoagulants (DOACs) were developed as an alternative to warfarin to treat and prevent thromboembolism, including stroke prevention in non-valvular atrial fibrillation patients. The COVID-19 pandemic could increase the risk of stroke and/or the risk of bleeding in patients due to nonadherence or sub/supra-optimal dosing.Objective To investigate DOAC prescription trends in England’s community settings during the complete first wave of COVID-19 pandemic.Methods Descriptive and interrupted time series (ITS) analyses were conducted to examine the prescription patterns of DOACs (dabigatran, rivaroxaban, apixaban and edoxaban) and warfarin for primary care patients in the English Prescribing Dataset from January 2019 to February 2021, with March 2020 as the cut-off point.Results A 19% increase in mean DOAC’s accompanied with 20% warfarin prescriptions decline was observed. ITS modelling showed an increase in DOAC prescription volume in March 2020 (+7 million items, p = 0.008). The pre-existing upward trend in DOAC prescriptions slowed during the period (-427,000 items, p = 0.007). Apixaban was the most frequently used DOAC and had the largest step-change in March 2020 (+5 million items, p = 0.010). The mean monthly combined cost of DOACs and warfarin was higher during the period. DOAC prescription trends were consistent across England’s regions. Conclusion: The overall oral anticoagulants use in this period was lower than expected, indicating a medical needs gap, possibly due to adherence issues. The potential clinical and logistical consequences warrant further study to identify contributing factors and mitigate avoidable risks.