Trends in Use of Warfarin and Direct Oral Anticoagulants

Study Questions:

Since the direct oral anticoagulants (DOACs) (i.e., dabigatran, rivaroxaban, apixaban, and edoxaban) have been brought into market sequentially since 2010, what is the utilization of anticoagulation and its impact on management of atrial fibrillation?


This was an analysis of data from the IMS Health National Disease and Therapeutic Index (NDTI), an ongoing survey of office-based physicians in the United States. The NDTI survey captures information on all clinic visits during two consecutive working business days per quarter. The primary unit of analysis was a treatment visit, defined as an office visit in which an OAC was used. The use of warfarin and the DOACs between 2009 and 2014 was estimated.


Overall, anticoagulation treatment visits increased from 2.05 million (95% confidence interval [CI], 1.82M-2.27M) in the second quarter (Q2) of 2009, to 2.83 million (95% confidence interval [CI], 2.49M-3.17M) in the fourth quarter (Q4) of 2014. Use of all OACs in treatment visits for atrial fibrillation increased from 0.88M (95% CI, 0.74M-1.02M) to 1.72M (95% CI, 1.47M-1.97M; p < 0.001), with similar DOAC and warfarin use in 2014 (the increase in total anticoagulant use for atrial fibrillation visits has been largely driven by a more than threefold increase in DOAC use between 2013/Q2 and 2014/Q4). In 2014, rivaroxaban was the most commonly prescribed DOAC for atrial fibrillation.


Since 2009, there has been rapid adoption of DOACs, and their use now matches that of warfarin.


This is a valuable study that provides insight into the ambulatory utilization of the DOACs, compared to warfarin. As the authors demonstrate, the use of DOACs now accounts for one half of all anticoagulant use during office visits for atrial fibrillation. And DOAC adoption is associated with an increased number of patients being treated with anticoagulation, countering concerns that there may be undertreatment of patients with atrial fibrillation who are at escalated risk of stroke.

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