Time trends and treatment pathways in the prescribing of individual oral
anticoagulants in patients with non-valvular atrial fibrillation: an
observational study of more than three million patients from Europe and
the United States
Abstract
Background: Data directly comparing trends in the use of different oral
anticoagulants (OACs) among patients with atrial fibrillation (AF) from
different countries are limited. We addressed this using a large-scale
network cohort study in the United States (US), Belgium, France, Germany
and United Kingdom (UK). Methods: We used nine databases (claims or
electronic health records) that had been converted into the
Observational Medical Outcomes Partnership Common Data Model with
analysis performed using open-source analytical tools. We identified
adults with AF and a first OAC prescription, either vitamin K antagonist
(VKA) or direct oral anticoagulant (DOAC) from 2010–2017. We described
time-trends in use, continuation and switching. Results: In 2010,
87.5%–99.8% of patients started on a VKA. By 2017, the majority
started on a DOAC: 87.0% (US), 88.3% (Belgium), 93.1% (France),
88.4% (Germany), 86.1%–86.7% (UK). In the UK, DOACs became the most
common starting OAC in 2015, 2–3 years later than elsewhere. Apixaban
was the most common starting OAC by 2017: 50.2%–57.8% (US), 31.4%
(Belgium), 45.9% (France), 39.5% (Germany), 49.8%– 50.5% (UK),
followed by rivaroxaban; 24.8%–32.5% (US), 25.7% (Belgium), 38.4%
(France), 24.9% (Germany), 30.2%– 31.2% (UK). Long-term treatment
was less common in the US than in Europe, especially the UK. A minority
of patients switched from their index OAC, both in the short- and
long-term. Conclusions: From 2010–2017, VKA use had significantly
declined and DOAC use had significantly increased in the US and Europe;
apixaban was the most prescribed OAC in 2017 followed by rivaroxaban.