Changing trends in the use of novel oral anticoagulants and warfarin for treating non-valvular atrial fibrillation

Background: Prevention of thromboembolism by novel anticoagulants (NOACs) is increasing, whilst use of vitamin K antagonists (VKAs) is on the decline. We assessed changes in the use of these anticoagulants in treating non-valvular AF (NVAF) between 2014 and 2018.
Methods: 162 consecutive patients (95 men, 67 women) with NVAF, mean age 72.3yrs (SD=11.0), underwent cardiac assessment in a single Cardiac Unit. Use of anticoagulants at the time of investigation was documented: overall 83 (51.2%) patients were prescribed NOACs and 79 (48.8%) warfarin treatment. Trends in treatment rates with either anticoagulant class over time were characterised by calculating the average annual percentage change (AAPC) using a Joinpoint Regression Program 4.7.0.0.
Results: There were diverging trends in anticoagulant treatment from 2014-2018 without join-points: yearly increase in NOAC treatment (41.9, 45.5, 53.7, 53.1 and 72.7%, AAPC = 16.2%, 95% CI = 5.8% to 27.5%, p <0.001), and decrease in warfarin treatment (57.1, 54.5, 46.3, 46.9 and 27.3%, AAPC = -14.4%, 95% CI = -25.2% to -2.1%, p <0.001).
Conclusions: Changing trends in treatment with anticoagulants for patients with NVAF observed within less than two years provides important information to healthcare services to estimate future pharmaco-economic costs for such treatments.