National Trends in Oral Anticoagulant Use in the United States, 2007 to 2011

Abstract

Background Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States. Methods and Results We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of office-based providers, to quantify patterns of oral anticoagulant use among all subjects and stratified by clinical indication. We quantified oral anticoagulant expenditures using the IMS Health National Prescription Audit. Between 2007 and 2011, warfarin treatment visits declined from approximately 2.1 million [M] quarterly visits to approximately 1.6M visits. Dabigatran use increased from 0.062M quarterly visits (2010Q4) to 0.363M visits (2011Q4), reflecting its increasing share of oral anticoagulant visits from 3.1% to 18.9%. In contrast to warfarin, the majority of dabigatran visits have been for atrial fibrillation, though this proportion decreased from 92% (2010Q4) to 63% (2011Q4), with concomitant increases in dabigatran’s off-label use. Among atrial fibrillation visits, warfarin use decreased from 55.8% of visits (2010Q4) to 44.4% (2011Q4), while dabigatran use increased from 4.0% to 16.9%. Of atrial fibrillation visits, the fraction not treated with any oral anticoagulants has remained unchanged at approximately 40%. Expenditures related to dabigatran increased rapidly from $16M in 2010Q4 to $166M in 2011Q4, exceeding expenditures on warfarin ($144M) in 2011Q4. Conclusions Dabigatran has been rapidly adopted into ambulatory practice in the United States, primarily for treatment of atrial fibrillation, but increasingly for off-label indications. We did not find evidence that it has increased overall atrial fibrillation treatment rates.

On-Treatment Outcomes in Patients With Worsening Renal Function With Rivaroxaban Compared With Warfarin

“…[1][2][3][4] In these patients, anticoagulants are not always administered because of concern that bleeding may outweigh the potential benefit. 5,6 Although anticoagulation with warfarin or the novel anticoagulants (NOACs), which have been rapidly adopted into routine clinical practice, 7 without excessive bleeding risk can be achieved in those with moderately reduced baseline renal function, [8][9][10] patients exhibit a decline in renal function over time that appears to be greater in those taking warfarin. 11 However, it is unknown whether outcomes differ among patients with worsening renal function (WRF) compared with those with stable renal function (SRF) while taking a NOAC compared with warfarin.…”

Comparison of Dabigatran and Uninterrupted Warfarin in Patients With Atrial Fibrillation Undergoing Cardiac Rhythm Device Implantations

“…9 Therefore, the periprocedural management of patients who are receiving modern anticoagulation therapy is a rapidly growing and complex clinical problem that requires further careful evaluation. dabigatran was initiated 12 h after the procedure, a transient ischemic attack without any lasting neurological deficits occurred.…”

Thromboprophylaxis for Hip and Knee Arthroplasty: Current Managements and Review of the Literature

“…Althoug it is used orally, it has some restriction such as bleeding risk, potantial drug interaction and requirement for constant monitoring (INR) [16]. Due to orally administration, it provides more compliance compared with parenteral antithrombotic agents.…”