Background and importance Direct oral anticoagulants (DOAC) were moderately used in the primary care (PC) setting due to their associated risks in elderly and their high cost. In contrast, acenocumarol was much more common in Catalonia, even though it requires intense monitoring. During the SARS-CoV-2 pandemic, the use of DOAC has been encouraged to reduce patient medical visits.
Aim and objectives To analyse the change in DOAC use in our area and to evaluate prescription appropriateness.
Material and methods This cross sectional study analysed the use of DOAC in a PC population in Barcelona in September 2020. The results were compared with historical data from December 2018. Demographic variables (age, gender), pharmacotherapeutic data (drugs, dose, frequency) and clinical data (glomerular filtration (GF), international normalised ratio (INR), CHA2DS2-VASc score) were obtained from the electronic medical record (September 2020). Prescription appropriateness was evaluated according to the drugs’ summary of product characteristics.
Results The study included 351 732 patients in 2018 and 364 350 in 2020; 9194 (2.65%) and 10 017 (2.75%) of the patients were treated with oral anticoagulants (OA), respectively.
Prevalence of OA use:
2018: acenocumarol 5734 (62.4%), warfarin 133 (2.3%), apixaban 1006 (10.9%), edoxaban 309 (3.4%), dabigatran 532 (5.8%) and rivaroxaban 1480 (16.1%).
2020: acenocumarol 3804 (38.0%), warfarin 157 (1.6%), apixaban 1875 (18.7%), edoxaban 959 (9.6%), dabigatran 712 (7.1%) and rivaroxaban 2510 (25.1%).
Comparison of prevalence between 2018 and 2020:
Decrease in acenocumarol (62.4% vs 38.0%, p<0.0001).
No change in warfarin (1.45% vs 1.6%, p<0.05).
Increase in DOAC (36.2% vs 60.5%, p<0.0001), specifically: increase in edoxaban (9.3% vs 15.8%, p<0.0001), no change in apixaban (30.2% vs 31.0%, p<0.05) and decrease in dabigatran and rivaroxaban (16.0% vs 11.8% and 44.5% vs 41.5%, respectively, p<0.05).
DOAC prescription appropriateness in 2020 (among 6056 patients):
The main indication was atrial fibrillation (5881 patients, 97.1%).
373 men had CHA2DS2–VASc <2 and 240 women had CHA2DS2–VASc <3.
Frequency of contraindications: peptic ulcer (1603; 26.5%), valvulopathy (1060; 17.5%) and renal failure (76; 1.3%).
2433 (40.2%) patients had at least one contraindication.
Dose was not appropriately reduced in 526 patients (8.7%).
Conclusion and relevance DOAC use increased notably in our PC area during the SARS-CoV-2 pandemic.
We found that 40.2% of patients treated with DOAC had at least one contraindication for the treatment. Interventions should be done to improve DOAC prescription and ensure patient safety.
Conflict of interest No conflict of interest
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