Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Basic Clin Pharmacol Toxicol. 2018 Oct;123(4):452-463. doi: 10.1111/bcpt.13024. Epub 2018 Jun 5.
We aimed to provide detailed utilization data on the total use of non-vitamin K antagonist oral anticoagulants (NOACs) since their introduction in 2008. Using the nationwide Danish National Prescription Registry, we identified all individuals filling prescriptions for NOACs 2008-2016. We reported the development in incident and prevalent users and explored baseline characteristics and treatment persistence according to treatment indication. A total of 126,691 NOAC users were identified within the Danish population of 5.7 million inhabitants. The annual incidence and prevalence increased rapidly reaching 10 and 17 per 1000 individuals in 2016. Patients received NOACs due to atrial fibrillation (AF) (43%), venous thromboembolism (VTE) prophylaxis after arthroplastic surgery (17%), VTE (12%) and no registered indication (28%). The most frequently used NOAC was rivaroxaban (n = 52,431), followed by dabigatran (n = 47,067), apixaban (n = 27,116) and edoxaban (n = 77). The proportion of AF and VTE patients initiating low-dose NOACs were between 23% and 50%. Patients treated with NOAC for VTE primarily received rivaroxaban. We observed a trend towards increased use of apixaban and rivaroxaban at the expense of dabigatran. Treatment persistence was highly dependent on treatment indication. Persistence to NOAC after 3 years was only 62% in AF compared to 28% for VTE. We documented an accelerating increase in the use of all four NOACs in the first 8 years after introduction. We have identified areas requiring further attention, including reasons for missing indications, potential inappropriate dosing and low long-term persistence with NOACs in patients with AF.
我们旨在提供自 2008 年非维生素 K 拮抗剂口服抗凝剂 (NOAC) 引入以来的总使用情况的详细利用数据。使用全国性的丹麦国家处方登记处，我们确定了 2008-2016 年期间所有开具 NOAC 处方的个体。我们报告了新发病例和现患病例使用者的发展情况，并根据治疗指征探讨了基线特征和治疗持续性。在丹麦 570 万居民中，共确定了 126691 名 NOAC 使用者。年度发病率和患病率迅速增加，2016 年达到每 1000 人中有 10 人和 17 人。由于房颤 (AF) (43%)、关节成形术后静脉血栓栓塞症 (VTE) 预防 (17%)、VTE (12%)和未登记的指征 (28%)，患者接受了 NOAC 治疗。最常使用的 NOAC 是利伐沙班 (n = 52431)，其次是达比加群 (n = 47067)、阿哌沙班 (n = 27116) 和依度沙班 (n = 77)。开始使用低剂量 NOAC 的 AF 和 VTE 患者比例在 23%至 50%之间。VTE 患者接受 NOAC 治疗的主要是利伐沙班。我们观察到阿哌沙班和利伐沙班的使用呈上升趋势，而达比加群的使用则呈下降趋势。治疗持续性高度依赖于治疗指征。AF 患者 3 年后对 NOAC 的持续率仅为 62%，而 VTE 患者的持续率为 28%。我们记录了在引入后的头 8 年中，所有四种 NOAC 的使用都在加速增加。我们已经确定了需要进一步关注的领域，包括缺失指征的原因、潜在的不适当剂量以及 AF 患者对 NOAC 的长期持续性低。
