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

Kjerpeseth, Lars Jøran; Ellekjær, Hanne; Selmer, Randi; Ariansen, Inger; Furu, Kari; Skovlund, Eva

doi:10.1007/s00228-017-2296-1

Cited by 71 publications

(83 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recent years have seen a rapid increase in the proportion of patients with atrial fibrillation (AF) starting anticoagulant therapy with a non-vitamin K antagonist oral anticoagulant (NOAC), replacing use of vitamin K antagonists (VKAs) as leading oral anticoagulant (OAC) therapy, both in the UK,1–3 and elsewhere in Europe 4–7. Decisions to prescribe standard or reduced dose NOACs are made on the basis of specific considerations such as age, weight, renal function and use of specific concomitant medications.…”

Section: Introductionmentioning

confidence: 99%

Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK

et al. 2019

View full text Add to dashboard Cite

ObjectiveTo evaluate the appropriateness of the initial prescribed daily dose of non-vitamin K antagonist oral anticoagulants (NOACs) according to label in patients with non-valvular atrial fibrillation (NVAF) in the UK.DesignPopulation-based cross-sectional study.SettingUK primary care.Population30 467 patients with NVAF and a first prescription for apixaban, dabigatran or rivaroxaban between January 2011 and December 2016.Main outcome measuresPercentage of patients prescribed a NOAC dose according to the European Union (EU) labels (appropriately dosed), and not according to the EU labels (inappropriately dosed—including both underdosed and overdosed patients); percentage of patients prescribed an initial NOAC dose according to renal function status.ResultsA total of 15 252 (50.1%) patients started NOAC therapy on rivaroxaban, 10 834 (35.6%) on apixaban and 4381 (14.4%) on dabigatran. Among patients starting NOAC therapy on rivaroxaban, 17.3% were eligible to receive a reduced dose compared with 12.8% of patients starting on apixaban and 53.8% of patients starting on dabigatran. The majority of patients were prescribed an appropriate dose according to the EU labels: apixaban 74.9 %, dabigatran, 74.4%; rivaroxaban, 84.2%. Underdosing occurred in 21.6% (apixaban), 8.7% (dabigatran), 9.1% (rivaroxaban). Overdosing was more frequent for dabigatran (16.9%) than for rivaroxaban (6.6%) or apixaban (3.5%). There was a trend towards dose reduction with increasing renal impairment. Among patients with severe renal impairment, the majority received a reduced dose NOAC: apixaban, 91.1%, dabigatran, 80.0%, rivaroxaban, 83.0%.ConclusionBetween 2011 and 2016, the majority of patients starting NOAC therapy in UK primary care were prescribed a daily dose in line with the approved EU drug label. Underdosing was more than twice as common among patients starting on apixaban than those starting on dabigatran or rivaroxaban. Research into the patient characteristics that may influence inappropriate underdosing of NOACs in UK primary care is warranted.

show abstract

Section: Introductionmentioning

confidence: 99%

Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK

et al. 2019

View full text Add to dashboard Cite

show abstract

“…4 Dabigatran was adopted very rapidly for the treatment of atrial fibrillation in both Europe 5 and USA. 6,7 After their introduction, rivaroxaban and apixaban also achieved substantial market shares within their first year of availability, 5,7,8 at the expense of dabigatran, which over the years have become a less preferred anticoagulant choice, most likely due to its limited use in renal failure patients and the increased risk of gastrointestinal bleeding. 9,10 The role for edoxaban in a market with 4 similar drugs is not immediately obvious.…”

Section: Introductionmentioning

confidence: 99%

Use of direct oral anticoagulants in the first year after market entry of edoxaban: A Danish nationwide drug utilization study

Pottegård

Grove

Hellfritzsch

2017

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

show abstract

“…Collectively, these agents have been approved by the United States Food and Drug Administration (US FDA) for prevention of stroke and systemic embolism in non‐valvular atrial fibrillation, prevention and treatment of venous thromboembolism (VTE), and secondary prevention of arterial ischemic events in patients with chronic coronary or peripheral artery disease . As a class, DOACs have now eclipsed vitamin K antagonists (VKAs) as the most widely prescribed oral anticoagulants in the Unites States and elsewhere …”

Section: Introductionmentioning

confidence: 99%

Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum

Cuker

Burnett

Triller³

et al. 2019

American J Hematol

269

263

View full text Add to dashboard Cite

Two specific reversal agents for direct oral anticoagulants (DOACs) have been approved in the United States: idarucizumab for dabigatran reversal and andexanet alfa for apixaban and rivaroxaban reversal. Non‐specific prohemostatic agents such as prothrombin complex concentrate (PCC) and activated PCC have also been used for DOAC reversal. The goal of this document is to provide comprehensive guidance from the Anticoagulation Forum, a North American organization of anticoagulation providers, regarding use of DOAC reversal agents. We discuss indications for reversal, provide guidance on how the individual reversal agents should be administered, and offer suggestions for stewardship at the health system level.

show abstract

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

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

Cited by 71 publications

References 37 publications

Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK

Appropriateness of initial dose of non-vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation in the UK

Use of direct oral anticoagulants in the first year after market entry of edoxaban: A Danish nationwide drug utilization study

Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum

Contact Info

Product

Resources

About