Background International guidelines have embraced the use of non-vitamin K oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation. However, there is controversy regarding the risk of bleeding of NOACs compared with vitamin K antagonists.
Purpose To analyse the evolution of consumption of oral anticoagulants (OACs) (2008–2015) and the economic impact of the recently marketed NOACs. To study major bleedings (intracranial haemorrhage (ICH) and gastrointestinal (GI) bleeding) experienced by our patients (2012–2015).
Material and methods This was an observational descriptive study. Field of study: two tertiary hospitals and their reference areas. The target population consisted of 666 000 people. Patients with an acenocoumarol, warfarin, dabigatran, rivaroxaban or apixaban prescription, under the National Health System coverage, were studied. The unit of measure was defined daily doses (DDD) per 1000 inhabitants per day (DHD), using the ATC/DDD classification (2006). The number of patients who experienced ICH or GI bleeding associated with OACs prescriptions was studied.
Results 24 498 patients were included with a mean age of 76.7 years. During the study period, DHD increased by 88.9%; from 6.3 (2008) to 11.8 (2015). DHD values in 2015 were: 6.6 acenocoumarol; 0.6 warfarin; 2.7 dabigatran; 1.3 rivaroxaban; and 0.6 apixaban. In 2015, 91.4% of patients were treated with acenocoumarol (12 370) and warfarin (848); the other 8.6% were treated with NOACs (dabigatran 480, rivaroxaban 494 and apixaban 267). The number of patients treated with OACs increased by 44.6% during the study period, but the total expense increased by 573.8% from €232 650 (2008) to €1 567 675 (2015).
Between 2012 and 2015, the number of patients with major bleeding was, respectively, 146, 136, 128 and 121. Associated with NOACs: 2, 8, 10 and 12, respectively. In 2015, 0.7% of patients with NOACs experienced major bleeding versus 0.6% of patients treated with warfarin and acenocoumarol. The percentage for each treatment was: 0.6% acenocoumarol; 0.4% warfarin; 1.2% dabigatran; 0.5% rivaroxaban; and 0% apixaban.
Conclusion Consumption of OACs has increased notably. However, overall expenditure on oral anticoagulant medications has grown, particularly due to the introduction of NOACs into the market, even though our data did not show a favourable safety profile with respect to bleeding.
No conflict of interest
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.