Direct oral anticoagulants uptake and an oral anticoagulation paradox.
Cormac KennedyCaitriona Ni ChoitirSarah ClarkeKathleen BennettMichael BarryPublished in: British journal of clinical pharmacology (2020)
Oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation is underutilised. One of the impediments to warfarin therapy is the frequent monitoring required, usually at a specialised warfarin clinic. The advent of direct oral anticoagulants (DOACs) facilitates OAC therapy without an onerous monitoring regimen. This benefit may result in the more significant adoption of DOACs in areas without a warfarin clinic. This study analysed national administrative data for reimbursed pharmacy claims to assess OAC prescribing from 2010 to 2017 and compared the use of DOACs in areas with warfarin clinics compared to those without. Over the study period, the number of patients on OAC increased by 84%, due to a rapid increase in DOAC prescribing. The findings demonstrate that DOACs have resulted in an increase in the overall uptake of OAC therapy in Ireland. However, the increased utilisation was not evidently related to populations underserved by warfarin clinics.
Keyphrases
- direct oral anticoagulants
- atrial fibrillation
- venous thromboembolism
- primary care
- oral anticoagulants
- electronic health record
- end stage renal disease
- newly diagnosed
- stem cells
- ejection fraction
- emergency department
- mesenchymal stem cells
- deep learning
- cell therapy
- health insurance
- big data
- prognostic factors
- bone marrow
- adverse drug
- brain injury
- patient reported