ArticleBMJ open2018
Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 57 citations in OpenAlex.
- An Updated Pooled Analysis of Off-Label Under and Over-Dosed Direct Oral Anticoagulants in Patients with Atrial Fibrillation.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial.BMC family practice · 2020Trial
- Equivalent inpatient mortality among direct-acting oral anticoagulant and warfarin users presenting with major hemorrhage.Thrombosis research · 2020Trial
- Bleeding Risk With Apixaban Versus Rivaroxaban: A Reference Trial Emulation Predicting the Results of COBRRA-VTE and COBRRA-AF Using US Health Care Claims.Circulation. Population health and outcomes · 2026Observational
- Risk of Cancer Comparing Warfarin and Direct Oral Anticoagulants: Population-Based Cohort Studies in England and Hong Kong.Drug safety · 2026Article
- Observational
- Risk of mortality between warfarin and direct oral anticoagulants: population-based cohort studies.BMC medicine · 2024Article
- Initiation patterns of anticoagulants for atrial fibrillation among older UK adults with and without chronic kidney disease, 2010-2020.Open heart · 2024Article
- Impact of COVID-19 Pandemic on Temporal Trends of Hemostasis Test in France: A Retrospective Analysis of 9 Years of National Health Data.TH open : companion journal to thrombosis and haemostasis · 2023Article
- Reimbursement and use of oral anticoagulants during 2014-2022 - A register-based study.Exploratory research in clinical and social pharmacy · 2023Article
- Association of Alternative Anticoagulation Strategies and Outcomes in Patients With Ischemic Stroke While Taking a Direct Oral Anticoagulant.Neurology · 2023Article
- Time Trends in Patient Characteristics of New Rivaroxaban Users with Atrial Fibrillation in Germany and the Netherlands.Drugs - real world outcomes · 2023Article
- Time Trends in Patient Characteristics, Anticoagulation Treatment, and Prognosis of Incident Nonvalvular Atrial Fibrillation in the Netherlands.JAMA network open · 2023Article
- Article
- Nine-Year Trends in Prevention of Thromboembolic Complications in Elderly Patients with Atrial Fibrillation Treated with NOACs.International journal of environmental research and public health · 2022Article
- Patient-specific and healthcare real-world costs of atrial fibrillation in individuals treated with direct oral anticoagulant agents or warfarin.BMC health services research · 2021Article
- Predictors, time course, and outcomes of persistence patterns in oral anticoagulation for non-valvular atrial fibrillation: a Dutch Nationwide Cohort Study.European heart journal · 2021Article
- Why Did All Patients with Atrial Fibrillation and High Risk of Stroke Not Receive Oral Anticoagulants? Results of the Polish Atrial Fibrillation (POL-AF) Registry.Journal of clinical medicine · 2021Article
- Impact of anticoagulant exposure misclassification on the bleeding risk of direct oral anticoagulants.British journal of clinical pharmacology · 2021Article
- Trends in Stroke Prevention between 2014 and 2018 in Hospitalized Atrial Fibrillation Patients.Cardiology research and practice · 2021Article
Corrections and comments
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Authors and funding
9 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveUnlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period.
methodsBased on the French National Health Administrative Database, we constituted a population-based cohort of all patients who were newly treated for NVAF between January 2011 and December 2015. Trends in drug use were described as the percentage of patients initiating each drug at the time of treatment initiation. A multivariate analysis using logistic regression model was performed to identify independent sociodemographic and clinical predictors of initial anticoagulant choice.
resultsThe cohort comprised 814 446 patients who had received a new anticoagulant treatment for NVAF. The proportion of patients using DOACs as initial anticoagulant therapy reached 54% 3 months after the Health Ministry approved the reimbursement of dabigatran for NVAF, and 61% by the end of 2015, versus VKA use. In the multivariate analysis, we found that DOAC initiators were younger and healthier overall than VKA initiators, and this tendency was reinforced over the 2011-2014 period. DOACs were more frequently prescribed by cardiologists in 2012 and after (adjusted OR in 2012: 2.47; 95% CI 2.40 to 2.54).
conclusionDespite recommendations from health authorities, DOACs have been rapidly and massively adopted as initial therapy for NVAF in France. Observational studies should account for the fact that patients selected to initiate DOAC treatment are healthier overall, as failure to do so may bias the risk-benefit assessment of DOACs.
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