ArticleBMC medicine2021
Prescribing of direct oral anticoagulants and warfarin to older people with atrial fibrillation in UK general practice: a cohort study.
Article in BMC medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review.Global heart · 2022Pooled it
- Understanding patient preferences, experiences and engagement with ambulatory heart rhythm monitoring: a scoping review.BMJ open · 2026Article
- Prescribing Practices, Polypharmacy, and Drug Interaction Risks in Anticoagulant Therapy: Insights from a Secondary Care Hospital.Journal of clinical medicine · 2026Article
- Age and gender disparities in oral anticoagulant use: a nine-year nationwide drug utilization analysis.Frontiers in pharmacology · 2026Article
- Review
- Vitamin K Antagonists (VKAs) and Novel Oral Anticoagulants (NOACs) Safety Comparison Based on Data from EudraVigilance Database.Hematology reports · 2025Article
- Temporal Trend Analysis of Atrial Fibrillation/Flutter Disease Burden in High-Income Countries Between 1990 and 2021.Reviews in cardiovascular medicine · 2025Article
- The Use of Direct Oral Anticoagulants (DOACs) in the Geriatric Population-How to Overcome the Challenges of Geriatric Syndromes.Journal of clinical medicine · 2025Review
- Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods.Heart (British Cardiac Society) · 2025Article
- Patient Characteristics and Real-World Treatment of Very Elderly Patients with Nonvalvular Atrial Fibrillation in Japan: An Administrative Claims Database Study.Cardiology and therapy · 2025Article
- Direct Oral Anticoagulant Use in Older Adults with Atrial Fibrillation: Challenges and Solutions.European cardiology · 2025Review
- Anticoagulant therapy in renal insufficiency theme: Anticoagulation in complex situations.Thrombosis research · 2024Review
- Prescription and switching patterns of direct oral anticoagulants in patients with atrial fibrillation.Research and practice in thrombosis and haemostasis · 2024Article
- Pharmacy-Led Management of Atrial Fibrillation: Improving Treatment Adherence and Patient Outcomes.Integrated pharmacy research & practice · 2024Review
- Anticoagulant use in older persons at risk for falls: therapeutic dilemmas-a clinical review.European geriatric medicine · 2023Review
- Article
- Direct Oral Anticoagulants in the Very Elderly.Thrombosis and haemostasis · 2023Article
- Article
- Incidence of nonvalvular atrial fibrillation and oral anticoagulant prescribing in England, 2009 to 2019: A cohort study.PLoS medicine · 2022Article
- Direct Medical Cost of Stroke and the Cost-Effectiveness of Direct Oral Anticoagulants in Atrial Fibrillation-Related Stroke: A Cross-Sectional Study.International journal of environmental research and public health · 2022Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAnticoagulation for stroke prevention in atrial fibrillation (AF) has, historically, been under-used in older people. The aim of this study was to investigate prescribing of oral anticoagulants (OACs) for people aged ≥ 75 years in the UK before and after direct oral anticoagulants (DOACs) became available.
methodsA cohort of patients aged ≥ 75 years with a diagnosis of AF was derived from the Clinical Practice Research Datalink (CPRD) between January 1, 2003, and December 27, 2017. Patients were grouped as no OAC, incident OAC (OAC newly prescribed) or prevalent OAC (entered study on OAC). Incidence and point prevalence of OAC prescribing were calculated yearly. The risk of being prescribed an OAC if a co-morbidity was present was calculated; the risk difference (RD) was reported. Kaplan-Meier curves were used to explore persistence with anticoagulation. A Cox regression was used to model persistence with warfarin and DOACs over time.
resultsThe cohort comprised 165,596 patients (66,859 no OAC; 47,916 incident OAC; 50,821 prevalent OAC). Incidence of OAC prescribing increased from 111 per 1000 person-years in 2003 to 587 per 1000 person-years in 2017. Older patients (≥ 90 years) were 40% less likely to receive an OAC (RD -0.40, 95% CI -0.41 to -0.39) than younger individuals (75-84 years). The likelihood of being prescribed an OAC was lower with a history of dementia (RD -0.34, 95% CI -0.35 to -0.33), falls (RD -0.17, 95% CI -0.18 to -0.16), major bleeds (RD -0.17, 95% CI -0.19 to -0.15) and fractures (RD -0.13, 95% CI -0.14 to -0.12). Persistence with warfarin was higher than DOACs in the first year (0-1 year: HR 1.25, 95% CI 1.17-1.33), but this trend reversed by the third year of therapy (HR 0.75, 95% CI 0.63-0.89).
conclusionsOAC prescribing for older people with AF has increased; however, substantial disparities persist with age and co-morbidities. Whilst OACs should not be withheld solely due to the risk of falls, these results do not reflect this national guidance. Furthermore, the under-prescribing of OACs for patients with dementia or advancing age may be due to decisions around risk-benefit management.
trial registrationEUPAS29923 . First registered on: 27/06/2019.
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