Related Experiment Video
Updated: Oct 24, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Changes in anticoagulant prescription patterns over time for patients with atrial fibrillation around the world
Monika Kozieł1,2, Christine Teutsch3, Valentina Bayer4
1Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool UK.
Background:
Prescribing patterns for stroke prevention in atrial fibrillation (AF) patients evolved with approval of non-Vitamin K antagonist oral anticoagulants (NOACs) over time.
Objectives:
To assess changes in anticoagulant prescription patterns in various geographical regions upon first approval of a NOAC and to analyze the evolution of oral anticoagulants (OACs) use over time in relation to CHA2DS2-VASc and HAS-BLED risk profiles.
Methods:
Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) Phases II and III reported data on antithrombotic therapy for patients with newly diagnosed AF and ≥1 stroke risk factor. We focused on sites enrolling patients in both phases and reported treatment patterns for the first 4 years after initial NOAC approval.
Results:
From GLORIA-AF Phases II and III, 27 432 patients were eligible for this analysis. When contrasting the first year with the fourth year of enrolment, the proportion of NOAC prescriptions increased in Asia from 29.2% to 60.8%, in Europe from 53.4% to 75.8%, in North America from 49.0% to 73.9% and in Latin America from 55.7% to 71.1%. The proportion of Vitamin K antagonists (VKAs) use decreased across all regions over time, in Asia from 26.0% to 9.8%, in Europe from 35.5% to 16.8%, in North America from 28.9% to 12.1%, and in Latin America from 32.4% to 17.8%. In the multivariable analysis, factors associated with NOAC prescription were as follows: enrolment year, type of site, region, stroke and bleeding risk scores, and type and categorization of AF.
Conclusions:
During 4 years after the approval of the first NOAC, NOAC use increased, while VKA use decreased, across all regions.
Insights
Non-Vitamin K antagonist oral anticoagulants (NOACs) use significantly increased, while Vitamin K antagonist (VKA) prescriptions declined globally in atrial fibrillation patients over four years post-NOAC approval.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Stroke prevention in atrial fibrillation (AF) is crucial.
- Prescribing patterns for AF stroke prevention have evolved with new anticoagulant options.
- Non-Vitamin K antagonist oral anticoagulants (NOACs) represent a significant advancement.
Purpose of the Study:
- To evaluate changes in oral anticoagulant (OAC) prescription patterns globally after the introduction of NOACs.
- To analyze the temporal trends in OAC use concerning patient risk profiles (CHA2DS2-VASc and HAS-BLED scores).
- To assess geographical variations in anticoagulant prescribing post-NOAC approval.
Main Methods:
- Analysis of data from the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) Phases II and III.
- Focus on patients with newly diagnosed AF and at least one stroke risk factor.
- Examination of treatment patterns during the first four years following the initial NOAC approval, comparing early and later enrollment periods.
Main Results:
- NOAC prescriptions increased substantially across all analyzed regions: Asia (29.2% to 60.8%), Europe (53.4% to 75.8%), North America (49.0% to 73.9%), and Latin America (55.7% to 71.1%).
- Vitamin K antagonist (VKA) use decreased across all regions: Asia (26.0% to 9.8%), Europe (35.5% to 16.8%), North America (28.9% to 12.1%), and Latin America (32.4% to 17.8%).
- Multivariable analysis identified enrollment year, site type, region, stroke/bleeding risk scores, and AF type as factors associated with NOAC prescription.
Conclusions:
- The introduction of NOACs led to a significant shift in anticoagulant prescribing for AF patients.
- NOAC uptake increased markedly, while VKA use diminished globally within four years of the first NOAC's approval.
- These changes reflect the evolving landscape of stroke prevention strategies in atrial fibrillation.
More Related Videos
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:15Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...