European Journal of Clinical Pharmacology

, Volume 73, Issue 11, pp 1417–1425 | Cite as

Trends in use of warfarin and direct oral anticoagulants in atrial fibrillation in Norway, 2010 to 2015

  • Lars J KjerpesethEmail author
  • Hanne Ellekjær
  • Randi Selmer
  • Inger Ariansen
  • Kari Furu
  • Eva Skovlund
Pharmacoepidemiology and Prescription



Since 2011, several direct oral anticoagulants (DOACs; dabigatran, rivaroxaban, apixaban) have been introduced as alternatives to warfarin for stroke prophylaxis in atrial fibrillation. We wanted to investigate changes in utilization of oral anticoagulants for atrial fibrillation in Norway following the introduction of DOACs.


Using nationwide registries, we identified all adults with pharmacy dispensings for warfarin or DOACs between January 2010 and December 2015 in Norway, and used ambulatory reimbursement codes to identify atrial fibrillation as indication. We defined incident use by a 1-year washout period. We describe trends in prevalent and incident use of warfarin and DOACs between 2010 and 2015, as well as patterns of treatment switching for incident users.


One hundred twenty-nine thousand two hundred eighty-five patients filled at least one prescription for an oral anticoagulant for atrial fibrillation; the yearly number of incident users increased from 262 to 421 per 100,000 person-years; and the yearly share of incident users who initiated a DOAC increased to 82%. Half the prevalent users were on a DOAC by 2015. Within a year of drug initiation, 6, 12, 16 and 20% of incident users of apixaban, rivaroxaban, warfarin and dabigatran, respectively, switched oral anticoagulant.


Use of DOACs for anticoagulation in atrial fibrillation became more prevalent between 2010 and 2015 in Norway, at the expense of warfarin.


Atrial fibrillation Drug utilization Warfarin Dabigatran Rivaroxaban Apixaban 


Authors’ contribution

LJK and RS did the analyses. LJK wrote the manuscript. All authors helped plan and design the study, interpret findings and revise the manuscript. All authors approved the final version of the manuscript.

Compliance with ethical standards

The Regional Committee for Medical and Health Research Ethics in Central Norway approved the study protocol before the study commenced. The Norwegian Data Protection Authority gave a licence to link registry data.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Public Health and NursingNorwegian University of Science and TechnologyTrondheimNorway
  2. 2.Department of NeuroscienceNorwegian University of Science and TechnologyTrondheimNorway
  3. 3.Stroke Unit, Department of Internal MedicineSt. Olav’s HospitalTrondheimNorway
  4. 4.Norwegian Institute of Public HealthOsloNorway

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