Department of Studies in Public Health, French National Health Insurance (Caisse Nationale de l'Assurance Maladie/Cnam), Paris, France.
University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology - UMR 1219, Bordeaux, France.
BMJ Open. 2019 Apr 20;9(4):e026645. doi: 10.1136/bmjopen-2018-026645.
To describe (i) the trend in oral anticoagulant (OAC) use following the introduction of non-vitamin K antagonist oral anticoagulant (NOAC) therapy for stroke prevention in atrial fibrillation (AF) patients and (ii) the current patterns of use of NOAC therapy in new users with AF in France.
(i) Repeated cross-sectional study and (ii) population-based cohort study.
French national healthcare databases (50 million beneficiaries).
(i) Patients with identified AF in 2011, 2013 and 2016 and (ii) patients with AF initiating OAC therapy in 2015-2016. PRIMARY AND SECONDARY OUTCOME MEASURES: (i) Trend in OAC therapy use in patients with AF and (ii) patterns of use of NOAC therapy in new users with AF.
Between 2011 and 2016, use of OAC therapy moderately increased (+16%), while use of antiplatelet therapy decreased (-22%) among all patients with identified AF. In 2016, among the 1.1 million AF patients, 66% used OAC therapy and were more likely to be treated by vitamin K antagonist (VKA) than NOAC therapy, including patients at higher risk of stroke (63.5%), while 33% used antiplatelet therapy. Among 192 851 new users of OAC therapy in 2015-2016 with identified AF, NOAC therapy (66.3%) was initiated more frequently than VKA therapy, including in patients at higher risk of stroke (57.8%). Reduced doses were prescribed in 40% of NOAC new users. Several situations of inappropriate use at NOAC initiation were identified, including concomitant use of drugs increasing the risk of bleeding (one in three new users) and potential NOAC underdosing.
OAC therapy use in patients with AF remains suboptimal 4 years after the introduction of NOACs for stroke prevention in France and improvement in appropriate prescribing regarding NOAC initiation is needed. However, NOAC therapy is now the preferred drug class for initiation of OAC therapy in patients with AF, including in patients at higher risk of stroke.
描述（i）在非维生素 K 拮抗剂口服抗凝药（NOAC）用于预防心房颤动（AF）患者中风后，口服抗凝药（OAC）的使用趋势，以及（ii）法国新 AF 患者中使用 NOAC 治疗的当前模式。
（i）重复横断面研究和（ii）基于人群的队列研究。
法国国家医疗保健数据库（5000 万受益人）。
（i）2011 年、2013 年和 2016 年确诊的 AF 患者，以及（ii）2015-2016 年开始 OAC 治疗的 AF 患者。
（i）AF 患者中 OAC 治疗的使用趋势，以及（ii）新 AF 患者中使用 NOAC 治疗的模式。
2011 年至 2016 年间，所有确诊 AF 患者中 OAC 治疗的使用率适度增加（+16%），而抗血小板治疗的使用率下降（-22%）。2016 年，在 110 万 AF 患者中，66%使用 OAC 治疗，与 NOAC 治疗相比，更有可能接受维生素 K 拮抗剂（VKA）治疗，包括中风风险较高的患者（63.5%），而 33%使用抗血小板治疗。在 2015-2016 年新使用 OAC 治疗的 192851 名 AF 患者中，NOAC 治疗（66.3%）的起始率高于 VKA 治疗，包括中风风险较高的患者（57.8%）。40%的新 NOAC 用户开具了减少剂量的药物。在开始使用 NOAC 时，发现了几种不合适的情况，包括同时使用增加出血风险的药物（三分之一的新用户）和潜在的 NOAC 剂量不足。
在法国引入 NOAC 预防中风后 4 年，AF 患者的 OAC 治疗使用率仍然不理想，需要改善 NOAC 起始的适当处方。然而，NOAC 治疗现在是 AF 患者开始 OAC 治疗的首选药物类别，包括中风风险较高的患者。
