The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed in this paper do not represent those of the committees. Thrombotic disorders, including stroke and venous thromboembolism VTE contribute to significant morbidity and mortality globally.
Stroke is the second most common cause of death, contributing to Atrial fibrillation AF is the most important cause of cardioembolic stroke, the most severe subtype of ischaemic stroke, and is associated with an up to 5-fold increased risk of stroke [ 2 ].
Given the significant mortality and morbidity burden of stroke and VTE, effective prophylaxis with oral anticoagulants OACs , including warfarin, and the non-vitamin k oral anticoagulants NOACs is essential. However, warfarin requires complex management that is often complicated because of its multiple interactions with foods and other medicines [ 9 , 10 ]. There is extensive under-treatment of those at risk of stroke; at least one-third of patients with AF and other known risk factors for stroke who are candidates for warfarin therapy do not receive it [ 14 ].
NOACs have many theoretical advantages over warfarin including comparable or superior efficacy in trial populations e. However, NOACs are also considerably more costly than warfarin [ 17 ]. Despite their importance, evidence on the use of NOACs and their consideration as an alternative to warfarin in the treatment of thrombotic conditions in Australia is limited. It found rapidly increasing use of NOACs in this population following their PBS listing for stroke prevention in AF and concluded that this may reflect use in those previously contraindicated to warfarin [ 18 ].
Fig 1 provides an overview of the introduction of the NOACs onto the Australian market for each of their approved indications for use. Notes: The dates shown above the timeline are the PBS listing reimbursement dates while the dates shown below the timeline are the Therapeutic Goods Administration TGA registration market approval dates for each of the approved indications for NOAC use.
Legend: Red: prevention of venous thromboembolic events VTE in adult patients who have undergone elective total hip or total knee replacement surgery; Green: prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation AF and at least one additional risk factor for stroke; Blue: Treatment Tx of deep vein thrombosis DVT and pulmonary embolism PE and for the prevention Pv of recurrent DVT and PE in adults.
To maintain consistency, the study population included continuous concessional beneficiaries individuals dispensed medicines attracting a concessional co-payment during the entire study dispensed anticoagulants. The PBS database does not capture data on medicines priced lower than the patient co-payment until at least April , and thereby under-ascertains the utilisation of certain medicines prior to this time [ 19 ]. As the concessional co-payment threshold is lower than the cost of nearly all medicines on the PBS, restricting to the concessional population allows for more complete capture of medicine use over time.
At the beginning of the study period during July , At the end of the study period during June , The dynamic nature of the study population did not allow for age-adjustment at a population level. This analysis included all OAC warfarin, rivaroxaban, dabigatran and apixaban dispensing records for continuous concessional beneficiaries during the study period of 1 July to 30 June Two intervention periods were examined: the initial listing of the first NOAC rivaroxaban in August ; and following the expanded indication for stroke prevention in AF in August for rivaroxaban; September for dabigatran and apixaban Fig 2.
The first intervention period August to July was compared with the pre-intervention period July to July , and the second intervention period August to June was compared with the first intervention period August to July The pre-intervention trend slope projected into the subsequent treatment period serves as the counterfactual and is statistically compared to provide an estimate of the effect of the interruption. Post-trend analysis estimates the post-intervention trends separately after the first and second intervention periods.
Autocorrelation and seasonality between time points were tested and found to be present. Stata version Total PBS expenditure on anticoagulants was separately calculated using Medicare Australia PBS item reports, which produce expenditure statistics based on requested PBS item codes and by patient category general or concessional [ 21 ].
PBS expenditure is reported as expenditure in the relevant year. However, this decreased substantially in the first year of the expanded NOAC listing from Rivaroxaban dispensing increased from 1. The proportion dispensed dabigatran was higher than those dispensed apixaban until October , when this observation was reversed.
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Skip to main content Try our corporate solution for free! Single Accounts Corporate Solutions Universities. This statistic displays the leading ten dispensed antiocoagulants and protamine in England in , by number of prescription items dispensed. In that year, warfarin sodium was the most popular prescribed anticoagulant at approximately 6. Loading statistic Show source.
Download for free You need to log in to download this statistic Register for free Already a member? Log in. Show detailed source information? Register for free Already a member? Treatment with anticoagulants may be recommended if your doctor feels you're at an increased risk of developing one of these problems.
This may be because you've had blood clots in the past or you've been diagnosed with a condition such as atrial fibrillation that can cause blood clots to form.
You may also be prescribed an anticoagulant if you've recently had surgery, as the period of rest and inactivity you need during your recovery can increase your risk of developing a blood clot. Read more about when anticoagulants are used. Your doctor or nurse should tell you how much of your anticoagulant medicine to take and when to take it.
Most people need to take their tablets or capsules once or twice a day with water or food. The length of time you need to keep taking your medicine for depends on why it's been prescribed.
In many cases, treatment will be lifelong. If you're unsure how to take your medicine, or are worried that you missed a dose or have taken too much, check the patient information leaflet that comes with it or ask your GP, anticoagulant clinic or pharmacist what to do. You can also call NHS for advice. Read more about anticoagulant dosage. There are a number of possible side-effects with anticoagulants and it is not possible to list all these here.
However, the major side-effect of all anticoagulant medicines is bleeding. People who take warfarin, acenocoumarol and phenindione need to have regular blood tests to measure how quickly the blood clots.
See the leaflet that comes with your particular brand for a full list of possible side-effects and cautions. These medicines sometimes react with other medicines that you may take.
So, make sure your doctor knows of any other medicines that you are taking, including ones that you have bought rather than been prescribed. One indication that you may be taking too much anticoagulant is that you may bleed or bruise easily. Also, if you bleed, the bleeding may not stop as quickly as normally. If any of the following serious bleeding side-effects occur while you are taking an anticoagulant you should see a doctor urgently and have a blood test:.
Some people who have no other risk factors for brain injury have an increased risk of bleeding after a head injury if they are taking anticoagulants. NICE recommends that people taking anticoagulant treatment should have a CT head scan within eight hours of their injury.
For a full list of people who cannot take an anticoagulant, please see the leaflet that comes with your medicine. If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme.
You can do this online at www. The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:. Jun M, Lix LM, Durand M, et al ; Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study.
Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation ; NICE Technology Appraisal Guidance - last updated July Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism ; NICE Technology Appraisal Guidance, July Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation ; NICE Technology Appraisal Guidance - last updated July
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