Impact of the COVID-19 pandemic on England’s national prescriptions of oral vitamin K antagonist (VKA) and direct-acting oral anticoagulants (DOACs): An interrupted time series analysis (January 2019 - February 2021)

Sajidah Alkhameys, Ravina Barrett

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Direct-acting oral anticoagulants (DOACs) were developed as an alternative to warfarin to treat and prevent thromboembolism, including stroke prevention in non-valvular atrial fibrillation patients. The COVID-19 pandemic could increase the risk of stroke and/or the risk of bleeding in patients due to nonadherence or sub/supra-optimal dosing. Objective: To investigate DOAC prescription trends in England’s community settings during the complete first wave of COVID-19 pandemic. Methods: Descriptive and interrupted time series (ITS) analyses were conducted to examine the prescription patterns of DOACs (dabigatran, rivaroxaban, apixaban and edoxaban) and warfarin for primary care patients in the English Prescribing Dataset from January 2019 to February 2021, with March 2020 as the cut-off point. Results: A 19% increase in mean DOAC’s accompanied with 20% warfarin prescriptions decline was observed. ITS modelling showed an increase in DOAC prescription volume in March 2020 (+7 million items, p = 0.008). The pre-existing upward trend in DOAC prescriptions slowed during the period (-427,000 items, p = 0.007). Apixaban was the most frequently used DOAC and had the largest step-change in March 2020 (+5 million items, p = 0.010). The mean monthly combined cost of DOACs and warfarin was higher during the period. DOAC prescription trends were consistent across England’s regions. Conclusion: The overall oral anticoagulants use in this period was lower than expected, indicating a medical needs gap, possibly due to adherence issues. The potential clinical and logistical consequences warrant further study to identify contributing factors and mitigate avoidable risks.

Original languageEnglish
Pages (from-to)1081-1092
Number of pages12
JournalCurrent Medical Research and Opinion
Volume38
Issue number7
DOIs
Publication statusPublished - 18 May 2022

Bibliographical note

Publisher Copyright:
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Keywords

  • Atrial fibrillation
  • COVID-19
  • SARS-CoV-2
  • anticoagulants
  • factor Xa inhibitors
  • stroke
  • thromboembolism
  • warfarin

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