Medical Research: What is the background for this study? What are the main findings?
Dr. Barnes: While warfarin has been the primary oral anticoagulant used for over 60 years, a new class of anticoagulants known as ‘direct oral anticoagulants’ (including dabigatran, rivaroxaban and apixaban) have been introduced within the last 5 years. These newer medications were developed to be easier for patients and physicians to use. While early data suggested quick adoption of these medications, there had not been a nation-wide assessment of their use and how specific diseases influenced the use of specific oral anticoagulants.
Using a national sample of office visits, we generated national estimates of oral anticoagulant use for patients between 2009 and 2014. The primary finding is that total number of office visits where an anticoagulant was used increased from 2.05 million to 2.83 million between 2009 and 2014, largely driven by a rapid increase in the use of the direct oral anticoagulant medications. Specifically among patient visits for atrial fibrillation, the total number of visits where an oral anticoagulant was used increased from 52% to 67%. This is important because there has long been concern about “under treatment” of atrial fibrillation and the risk of stroke for patients who do not receive anticoagulation. This study suggests that the direct oral anticoagulants may be helping to protect more patients with atrial fibrillation from strokes.
Medical Research: What should clinicians and patients take away from your report?
Dr. Barnes: This study suggests that clinicians are more frequently using oral anticoagulants for their atrial fibrillation patients. However, there are still a significant number of office visits where atrial fibrillation patients are not receiving any oral anticoagulants. We need to find ways to improve the use of anticoagulants for atrial fibrillation patients to help prevent life-threatening strokes.
The study also provides reassurance to providers that there is widespread and rapid adoption of the first three direct oral anticoagulants (dabigatran, rivaroxaban and apixaban). This class of medications now represents ~40% of all office visits where an oral anticoagulant was used.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Barnes: Future studies will need to understand how and why patients and providers select specific oral anticoagulants. Studies will also need to focus on strategies to further improve the use of oral anticoagulants for atrial fibrillation patients. Lastly, we will need to explore how the trend of increasing direct oral anticoagulant use continues in the future and the economic impact it has on healthcare spending.
Geoffrey Barnes, MD, MSc (2015). Oral Anticoagulation Medications Have Led To More Patients Treated For Atrial Fibrillation