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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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

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Author information

Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Lars J Kjerpeseth.

Ethics declarations

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.

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Kjerpeseth, L.J., Ellekjær, H., Selmer, R. et al. Trends in use of warfarin and direct oral anticoagulants in atrial fibrillation in Norway, 2010 to 2015. Eur J Clin Pharmacol 73, 1417–1425 (2017). https://doi.org/10.1007/s00228-017-2296-1

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Keywords

  • Atrial fibrillation
  • Drug utilization
  • Warfarin
  • Dabigatran
  • Rivaroxaban
  • Apixaban