Key result
COVID-19 pandemic shows no overall impact on anticoagulant initiation trends despite immediate NOAC drops in older patients.
Why the study?
The COVID-19 pandemic may have influenced anticoagulant initiation due to the disease's thrombogenic nature or societal impacts, but its effect was unclear.
Does the COVID-19 pandemic affect the initiation rate of anticoagulant drugs in the adult Swedish population?
Observational (n=492,177)
Does the COVID-19 pandemic affect the initiation rate of anticoagulant drugs in the adult Swedish population?
Effect estimate: Posttrend change coefficient 0.028 (95% CI -1.8-1.8)
p-value: p=0.98
The onset of the COVID-19 pandemic did not have a profound overall impact on the initiation of anticoagulants in Sweden, though it caused a notable immediate decrease in NOAC initiation among those aged ≥ 65 years and attenuated the pre-pandemic decline in warfarin use.
Transient NOAC dip in elderly at pandemic onset may signal access barriers; leaves open outcome effects and generalizability.
The COVID-19 pandemic may have increased anticoagulant initiation due to the thrombogenic nature of the disease or decreased due to the societal impact of the pandemic. We aimed to study the effect of the COVID-19 pandemic on initiation of anticoagulants in Sweden. We conducted a single interrupted time series analysis on the monthly cumulative incidence of nonvitamin K antagonist oral anticoagulants (NOAC), warfarin, or heparins, before and after March 2020, using SCIFI-PEARL dataset. For anticoagulants in total, there were no statistically significant changes or differences in the trends of initiation after the start of the pandemic. There was a slight numerical decrease in initiation after the onset of the pandemic, particularly for NOACs. For individuals aged ≥ 65 years, however, the immediate decrease in initiation was considerable for NOACs. The prepandemic declining trend of warfarin initiation seemed to attenuate, that is, became less negative, after March 2020. We did not find any profound effect of the COVID-19 pandemic on the initiation of anticoagulants in total. However, among individuals aged ≥ 65 years, a notable immediate decrease in initiation of NOACs was observed. Furthermore, the onset of the pandemic may have attenuated the downward temporal trend in initiation of warfarin use.
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Samuelsen et al. (2025) conducted an observational in General population (new users of anticoagulants) (n=492,177). COVID-19 pandemic onset vs. Pre-pandemic period (March 2019 to February 2020) was evaluated on Monthly cumulative incidence of patients initiating an anticoagulant drug (per 100,000 inhabitants) (Posttrend change coefficient 0.028, 95% CI -1.8-1.8, p=0.98). The onset of the COVID-19 pandemic did not significantly change the overall trend of anticoagulant initiation, though a notable immediate decrease in NOAC initiation was observed in patients ≥65 years.
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