Key result
DOAC uptake drives a ~37% increase in oral anticoagulation for elderly Japanese AF patients.
Why the study?
Few studies have reported on the current state of anticoagulant therapy at the national level in elderly patients with non-valvular atrial fibrillation.
How have prescription rates of DOACs versus VKAs changed over time in elderly Japanese patients with non-valvular atrial fibrillation?
Observational (n=12,076)
How have prescription rates of DOACs versus VKAs changed over time in elderly Japanese patients with non-valvular atrial fibrillation?
Absolute Event Rate: 56% vs 41%
The introduction of DOACs has led to a marked increase in overall anticoagulant use among elderly Japanese patients with non-valvular atrial fibrillation, including those at high risk for bleeding.
Increased OAC use in high-risk elderly AF supports expanded DOAC access; leaves open whether real-world outcomes improved.
Background and aim: The introduction of direct oral anticoagulants (DOACs) has greatly changed the use of anticoagulant therapy in patients with non-valvular atrial fibrillation (Af). However, few studies have reported on the current state of anticoagulant therapy at the national level. This study aimed to examine changes in the proportions of oral anticoagulant (OAC) prescriptions (4 DOACs and a vitamin K antagonist: VKA) in patients with non-valvular Af aged ≥65 years, taking into consideration the risk of cerebral infarction and bleeding.Methods: Anticoagulant prescriptions in outpatients with Af were temporally analyzed using the nationwide claims database in Japan. The proportion of anticoagulants prescribed to Af patients aged ≥65 years was determined. Trends in anticoagulant prescriptions were examined according to cerebral infarction and bleeding risk.Results: The proportion of anticoagulant prescriptions for 12,076 Af patients aged ≥65 years in Japan increased from 41% in 2011 to 56% in 2015. The proportion of prescriptions for DOACs surpassed that of VKA. An increase in DOAC prescriptions was accompanied by an increase in the proportion of anticoagulant prescriptions in each group according to the CHA2DS2-VASc and HAS-BLED scores. The proportion of anticoagulant prescriptions for patients with a high risk of developing cerebral infarction and bleeding showed a marked increase.Conclusion: Trends in anticoagulant prescriptions in patients with non-valvular AfAf in Japan showed a marked increase in DOAC prescriptions. The widespread use of DOACs greatly changes the profiles of cerebral infarction and bleeding risks, which are related to the prescription of anticoagulant therapy in patients with non-valvular Af.
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Tsuji et al. (2021) conducted an observational in Non-valvular atrial fibrillation (n=12,076). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonist (VKA) or no anticoagulant was evaluated on Proportion of anticoagulant prescriptions among Af patients aged ≥ 65 years (2015 vs 2011). The proportion of anticoagulant prescriptions for elderly patients with non-valvular atrial fibrillation in Japan increased from 41% in 2011 to 56% in 2015, driven by a marked increase in DOAC prescriptions.
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