Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
Br J Clin Pharmacol. 2017 Sep;83(9):2096-2106. doi: 10.1111/bcp.13299. Epub 2017 May 4.
Novel oral anticoagulants (NOACs) are alternatives to vitamin-K antagonists (VKAs) for the prevention of thromboembolism. It is unclear how NOACs have been adopted in the UK since first introduced in 2008. The present study was conducted to describe the trends in the prescription of NOACs in the UK, including dabigatran, rivaroxaban and apixaban.
Using the UK's Clinical Practice Research Datalink, the rates of new use of NOACs and VKAs from 2009 to 2015 were calculated using Poisson regression. Patient characteristics associated with NOAC initiation were identified using multivariate logistic regression.
The overall rate of oral anticoagulant initiation increased by 58% over the study period [rate ratio (RR) 1.58; 95% confidence interval (CI) 1.23, 2.03], even as the rate of new VKA use decreased by 31% (RR 0.69; 95% CI 0.52, 0.93). By contrast, the rate of initiation of NOAC increased, particularly from 2012 onwards, with a 17-fold increase from 2012 to 2015 (RR 17.68; 95% CI 12.16, 25.71). In 2015, NOACs accounted for 56.5% of oral anticoagulant prescriptions, with rivaroxaban prescribed most frequently, followed by apixaban and then dabigatran. Compared to VKAs, new NOAC users were less likely to have congestive heart failure, coronary artery disease and peripheral vascular disease, and more likely to have a history of ischaemic stroke.
In the UK, the rate of initiation of NOACs has increased substantially since 2009, and these agents have now surpassed VKAs as the anticoagulant of choice. Moreover, the characteristics of patients initiated on NOACs have changed over time, and this should be accounted for in future studies comparing NOACs and VKAs.
新型口服抗凝剂（NOACs）是维生素 K 拮抗剂（VKAs）在预防血栓栓塞方面的替代品。自 2008 年首次引入以来，NOACs 在英国的应用情况尚不清楚。本研究旨在描述 2009 年至 2015 年英国 NOACs（包括达比加群、利伐沙班和阿哌沙班）的应用趋势。
利用英国临床实践研究数据链，采用泊松回归计算 2009 年至 2015 年期间 NOACs 和 VKAs 的新使用率。采用多变量逻辑回归确定与 NOAC 起始相关的患者特征。
研究期间，口服抗凝剂起始率总体增加了 58%[调整后比值比（RR）1.58；95%置信区间（CI）1.23，2.03]，尽管新 VKAs 使用率下降了 31%（RR 0.69；95% CI 0.52，0.93）。相比之下，NOAC 起始率增加，特别是自 2012 年以来，2012 年至 2015 年增加了 17 倍（RR 17.68；95% CI 12.16，25.71）。2015 年，NOACs 占口服抗凝剂处方的 56.5%，其中利伐沙班应用最广泛，其次是阿哌沙班和达比加群。与 VKAs 相比，新使用 NOAC 的患者充血性心力衰竭、冠心病和外周血管疾病的发生率较低，而缺血性脑卒中的发生率较高。
自 2009 年以来，英国新使用 NOACs 的比例大幅增加，这些药物现已超过 VKAs 成为首选抗凝药物。此外，随着时间的推移，开始使用 NOACs 的患者的特征发生了变化，这在比较 NOACs 和 VKAs 的未来研究中应予以考虑。
