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A Comparison of Oral Anticoagulant Use for Atrial Fibrillation in the Pre- and Post-DOAC Eras

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Abstract

Introduction

Direct oral anticoagulants (DOACs) have seen rapid uptake for the prevention of stroke associated with non-valvular atrial fibrillation (NVAF). It is unclear whether use of DOACs represents direct therapeutic substitution over warfarin or if this coincides with an increase in overall treatment rates. This study sought to describe the difference in oral anticoagulant (OAC) use in the pre-DOAC and post-DOAC eras.

Methods

Incident cases of NVAF were identified from the Truven Marketscan database during the years 2005–2009 (‘pre-DOAC’) and 2013 (‘post-DOAC’). Demographic and clinical characteristics were compared for the overall cohorts and among those who did and did not receive OAC in both time periods. OAC treatment was observed by stroke (CHA2DS2-VASc) and bleed risk (HAS-BLED) scores. Logistic regression was used to compare the individual characteristics associated with OAC use between the study periods.

Results

During the pre- and post-DOAC eras, 105,610 and 11,992 NVAF patients were identified. OAC treatment increased from 42.2 to 54.0 % (absolute change 11.8 %, relative change 28.0 %) from the pre- to post-DOAC periods without meaningful differences between the populations. Larger relative increases in OAC treatment were observed for those at high risk of stroke (33.9 % increase) and for those with moderate (30.4 % increase) to high risk (28.6 % increase) of bleed. Other than time period of diagnosis, no patient characteristics differed between those treated with OACs in the pre and post periods.

Conclusions

There has been an overall increase in OAC use in the NVAF population, attributable to both favorable randomized trial results and aggressive marketing of DOACs in the USA.

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Acknowledgments

J. D. B is supported by a Research Fellowship sponsored by Humana Inc. and Pfizer Inc. Neither organization had any input into this study or in the drafting of the manuscript. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1TR000117. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. There are no other conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Pharmacy Practice and Science, Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, 789 S. Limestone St #292E, Lexington, KY, 40536, USA

    Joshua D. Brown & Jeffery C. Talbert

  2. Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Anand R. Shewale

  3. Internal Medicine, Banner University Medical Center-South, Tucson, AZ, USA

    Parinita Dherange

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  1. Joshua D. Brown
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Correspondence to Joshua D. Brown.

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Brown, J.D., Shewale, A.R., Dherange, P. et al. A Comparison of Oral Anticoagulant Use for Atrial Fibrillation in the Pre- and Post-DOAC Eras. Drugs Aging 33, 427–436 (2016). https://doi.org/10.1007/s40266-016-0369-y

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