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Oral anticoagulant use for treatment of AF rising
From 2009 to 2014, the use of direct oral anticoagulants for the treatment of patients with atrial fibrillation increased from 880,000 to 1.72 million, according to an analysis of outpatient office visits in the United States.
Researchers evaluated data on outpatient office visits collected via the IMS Health National Disease and Therapeutic Index. The index comprises data collected from office-based physicians in the United States and is intended to provide a nationally representative sample of disease patterns and treatment, according to study background information.
Office visits involving the use of a direct oral anticoagulant, including warfarin, apixaban (Eliquis, Bristol-Myers Squibb), dabigatran (Pradaxa, Boehringer Ingelheim) or rivaroxaban (Xarelto, Janssen Pharmaceuticals), for the treatment of adults with AF or venous thromboembolism were included in the analysis.
The number of office visits involving anticoagulation increased from 2.05 million (95% CI, 1.82-2.27) in 2009 to 2.83 million (95% CI, 2.49-3.17) in 2014 (P < .001). Office visits related to the use of direct oral anticoagulants, specifically, represented 38.2% of the total number of anticoagulation-related visits in 2014, whereas visits involving warfarin use declined between 2009 and 2014. The proportion of visits related to AF that involved anticoagulants rose from 51.9% (95% CI, 50.4-53.8) in 2009 to 66.9% (95% CI, 65-69.3) in 2014 (P < .001). The researchers noted that the use of warfarin and direct oral anticoagulants were similar for the treatment of AF.
Rivaroxaban was the most frequently prescribed direct oral anticoagulant for patients with AF in 2014, accounting for 47.9% of all visits. Apixaban was used in 26.4% of all visits and dabigatran in 25.4%.
Anticoagulant use for the treatment of VTE increased from 367,000 visits in 2009 to 583,000 visits in 2014 (P = .001). Since 2012, the use of direct oral anticoagulants for the treatment of VTE became more common and represented 36% of all visits related to VTE in 2014.
“The use of [direct oral anticoagulants] is rising rapidly and accounts for half of all anticoagulant use during AF office visits,” the researchers concluded. “[Direct oral anticoagulant] use is rising among venous thromboembolism office visits, largely replacing the use of warfarin. Our findings suggest that [direct oral anticoagulant] adoption is associated with an increase in the number of AF patients treated with anticoagulant therapy. It remains to be seen if these trends will continue or change once a [direct oral anticoagulant] reversal agent becomes available.” – by Adam Taliercio
Disclosure: One researcher reports receiving research funding from Bristol-Myers Squibb/Pfizer and Blue Cross-Blue Shield of Michigan, and receiving consultant fees from Portola Pharmaceuticals. Another researcher reports serving as chair of the FDA Peripheral and Central Nervous System Advisory Committee, as well as serving as a paid consultant and on a scientific advisory board for IMS Health.