Skip to main content
Log in

Trends in oral anticoagulant use in Qatar: a 5-year experience

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

In Qatar, dabigatran was introduced in 2011 followed by rivaroxaban in 2014. In this study, we aim to explore the trends in oral anticoagulant use in Qatar over the past 5 years and to what extent did DOACs replace warfarin. We also explored the extent of switching between different anticoagulants (from warfarin to DOACs and vice versa). We collected all anticoagulant prescriptions dispensed as in- or out-patient from 2011 to 2015 in all Hamad Medical Corporation (HMC) hospitals. Overall number of patients using warfarin, dabigatran and rivaroxaban over the last 5 years collectively was calculated. Per each calendar year, we calculated the number of all 3 OAC used (warfarin, dabigatran and rivaroxaban), frequency of use of each one of the OAC prescribed and compared the change in proportion of DOACs to warfarin prescriptions over the years. Overall, 6961 patients were using OAC over the past 5 years among which 5849 (84%) used warfarin, 496 (7.1%) used dabigatran and 616 (8.8%) used rivaroxaban. Oral anticoagulants use increased gradually from 2091 in 2011 to 3688 in 2015. Number of patients receiving DOACs increased significantly compared to warfarin [11 (0.5%) in 2011 vs. 849 (23%) in 2015 (p < 0.0001)]. Since its introduction in 2014, number of rivaroxaban users increased significantly compared to dabigatran [212 (40.9%) in 2014 vs. 544 (64.1%) in 2015]. DOACs have been gradually replacing warfarin in Qatar and the trend of their use is similar to that reported in other countries. Warfarin remains the most commonly used oral anticoagulant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Nutescu EA, Shapiro NL, Ibrahim S, West P (2006) Warfarin and its interactions with foods, herbs and other dietary supplements. Expert Opin Drug Saf 5(3):433–451. doi:10.1517/14740338.5.3.433

    Article  CAS  PubMed  Google Scholar 

  2. Pirmohamed M (2006) Warfarin: almost 60 years old and still causing problems. Br J Clin Pharmacol 62(5):509–511. doi:10.1111/j.1365-2125.2006.02806.x

    Article  PubMed  PubMed Central  Google Scholar 

  3. Nutescu EA, Spinler SA, Dager WE, Bussey HI (2004) Transitioning from traditional to novel anticoagulants: the impact of oral direct thrombin inhibitors on anticoagulation management. Pharmacotherapy 24(10Pt2):199S–202S

    Article  CAS  PubMed  Google Scholar 

  4. Horton JD, Bushwick BM (1999) Warfarin therapy: evolving strategies in anticoagulation. Am Fam Phys 59(3):635–646

    CAS  Google Scholar 

  5. Lip GY, Agnelli G (2014) Edoxaban: a focused review of its clinical pharmacology. Eur Heart J 35(28):1844–1855. doi:10.1093/eurheartj/ehu181

    Article  CAS  PubMed  Google Scholar 

  6. Skjoth F, Larsen TB, Rasmussen LH, Lip GY (2014) Efficacy and safety of edoxaban in comparison with dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation. An indirect comparison analysis. Thromb Haemost 111(5):981–988. doi:10.1160/TH14-02-0118

    Article  PubMed  Google Scholar 

  7. Spinler SA, Shafir V (2012) New oral anticoagulants for atrial fibrillation. Circulation 126(1):133–137. doi:10.1161/CIRCULATIONAHA.112.099283

    Article  PubMed  Google Scholar 

  8. Why Pradaxa. (2012). http://www.pradaxa.com. Accessed 22 Sept 2012

  9. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L, Committee R-LS, Investigators (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361(12):1139–1151. doi:10.1056/NEJMoa0905561

    Article  CAS  PubMed  Google Scholar 

  10. Spyropoulos AC, Goldenberg NA, Kessler CM, Kittelson J, Schulman S, Turpie AG, Cutler NR, Hiatt WR, Halperin JL, The Antithrombotic Trials L, Steering G (2012) comparative effectiveness and safety of the novel oral anticoagulants: do the pivotal clinical trials point to a new paradigm? J Thromb Haemost. doi:10.1111/jth.12005

    Google Scholar 

  11. Wallentin L, Yusuf S, Ezekowitz MD, Alings M, Flather M, Franzosi MG, Pais P, Dans A, Eikelboom J, Oldgren J, Pogue J, Reilly PA, Yang S, Connolly SJ, investigators R-L (2010) Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 376(9745):975–983. doi:10.1016/S0140-6736(10)61194-4

    Article  CAS  PubMed  Google Scholar 

  12. Pragst I, Zeitler SH, Doerr B, Kaspereit FJ, Herzog E, Dickneite G, van Ryn J (2012) Reversal of dabigatran anticoagulation by prothrombin complex concentrate (Beriplex P/N) in a rabbit model. J Thromb Haemost 10(9):1841–1848. doi:10.1111/j.1538-7836.2012.04859.x

    Article  CAS  PubMed  Google Scholar 

  13. Huang C, Siu M, Vu L, Wong S, Shin J (2012) Factors influencing doctors’ selection of dabigatran in non-valvular atrial fibrillation. J Eval Clin Pract. doi:10.1111/j.1365-2753.2012.01886.x

    Google Scholar 

  14. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the american college of cardiology/american heart association task force on practice guidelines and the heart rhythm society. J Am Coll Cardiol 64(21):e1–e76. doi:10.1016/j.jacc.2014.03.022

    Article  PubMed  Google Scholar 

  15. Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Vardas P, Al-Attar N, Alfieri O, Angelini A, Blömstrom-Lundqvist C, Colonna P, De Sutter J, Ernst S, Goette A, Gorenek B, Hatala R, Heidbüchel H, Heldal M, Kristensen SD, Le Heuzey J-Y, Mavrakis H, Mont L, Filardi PP, Ponikowski P, Prendergast B, Rutten FH, Schotten U, Van Gelder IC, Verheugt FWA (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association 33 (21):2719–2747. doi:10.1093/eurheartj/ehs253

  16. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores L (2016) Antithrombotic therapy for vte disease: chest guideline and expert panel report. Chest 149(2):315–352. doi:10.1016/j.chest.2015.11.026

    Article  PubMed  Google Scholar 

  17. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. CHEST J 149 (2):315–352

    Article  Google Scholar 

  18. Elewa H, AbdelSamad O, Elmubark A, Al-Taweel H, Mohamed A, Kheir N, Mohamed Ibrahim M, Awaisu A (2016) The first pharmacist-managed anticoagulation clinic under a collaborative practice agreement in Qatar: clinical and patient-oriented outcomes. J Clin Pharm Ther

  19. Elewa H, Jalali F, Khudair N, Hassaballah N, Abdelsamad O, Mohammed S (2016) Evaluation of pharmacist-based compared to doctor-based anticoagulation management in Qatar. J Eval Clin Pract. doi:10.1111/jep.12504

    PubMed  Google Scholar 

  20. Statistics MoDPa (2016) Ministry of Development Planning and Statistics. http://www.mdps.gov.qa/en/pages/default.aspx. Accessed 1 Dec 2016

  21. Barnes GD, Lucas E, Alexander GC, Goldberger ZD (2015) National trends in ambulatory oral anticoagulant use. Am J Med 128(12):1300–1305. e1302

    Article  PubMed  PubMed Central  Google Scholar 

  22. Southworth MR, Reichman ME, Unger EF (2013) Dabigatran and postmarketing reports of bleeding. N Engl J Med 368(14):1272–1274. doi:10.1056/NEJMp1302834

    Article  CAS  PubMed  Google Scholar 

  23. Graham DJ, Reichman ME, Wernecke M, Hsueh Y-H, Izem R, Southworth MR, Wei Y, Liao J, Goulding MR, Mott K (2016) Stroke, bleeding, and mortality risks in elderly Medicare beneficiaries treated with dabigatran or rivaroxaban for nonvalvular atrial fibrillation. JAMA Intern Med 176(11):1662–1671

    Article  PubMed  Google Scholar 

  24. Noseworthy PA, Yao X, Abraham NS, Sangaralingham LR, McBane RD, Shah ND Direct comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in non-valvular atrial fibrillation. Chest. doi:10.1016/j.chest.2016.07.013

  25. Avci BK, Vatan B, Tok OO, Aidarova T, Sahinkus S, Uygun T, Gunduz H, Karakaya O, Yuksel H, Ongen Z (2015) The trends in utilizing nonvitamin K antagonist oral anticoagulants in patients with nonvalvular atrial fibrillation a real-life experience. Clin Appl Thromb Hemost:1076029615581365

  26. Hanemaaijer S, Sodihardjo F, Horikx A, Wensing M, De Smet PA, Bouvy ML, Teichert M (2015) Trends in antithrombotic drug use and adherence to non-vitamin K oral anticoagulants in the Netherlands. Int J Clin Pharm 37(6):1128–1135

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Xu Y, Holbrook AM, Simpson CS, Dowlatshahi D, Johnson AP (2013) Prescribing patterns of novel oral anticoagulants following regulatory approval for atrial fibrillation in Ontario, Canada: a population-based descriptive analysis. CMAJ Open 1(3):E115–E119

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kirley K, Qato DM, Kornfield R, Stafford RS, Alexander GC (2012) National trends in oral anticoagulant use in the United States, 2007 to 2011. Circulation 5(5):615–621

    PubMed  PubMed Central  Google Scholar 

  29. Sørensen R, Gislason G, Torp-Pedersen C, Olesen JB, Fosbøl EL, Hvidtfeldt MW, Karasoy D, Lamberts M, Charlot M, Køber L (2013) Dabigatran use in Danish atrial fibrillation patients in 2011: a nationwide study. BMJ Open 3(5):e002758

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This report was made possible by Qatar University internal Grant # (QUST-CPH-FALL-15/16 − 3). The statements made herein are solely the responsibility of the authors.

Funding

This study was funded by Qatar University internal Grant # (QUST-CPH-FALL-15/16-3).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hazem Elewa.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elewa, H., Alhaddad, A., Al-Rawi, S. et al. Trends in oral anticoagulant use in Qatar: a 5-year experience. J Thromb Thrombolysis 43, 411–416 (2017). https://doi.org/10.1007/s11239-017-1474-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-017-1474-4

Keywords

Navigation