Trends in antithrombotic drug use and adherence to non-vitamin K oral anticoagulants in the Netherlands

Trends in antithrombotic drug use and adherence to non-vitamin K oral anticoagulants in the Netherlands

Background Non-vitamin K oral anticoagulants (NOACs) became available in the Netherlands in 2008, providing another antithrombotic treatment besides vitamin K antagonists (VKAs) and antiplatelet agents (APAs). Objective To describe the patterns of antithrombotic drug use between 2008 and 2013 by exa...

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Bibliographic Details
Published in:International journal of clinical pharmacy Vol. 37; no. 6; pp. 1128 - 1135
Main Authors: Hanemaaijer, Susan, Sodihardjo, Fong, Horikx, Annemieke, Wensing, Michel, De Smet, Peter A. G. M., Bouvy, Marcel L., Teichert, Martina
Format: Journal Article
Language:English
Published: Dordrecht Springer Netherlands 01-12-2015
Subjects:
Age Factors
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Antithrombins - administration & dosage
Drug Utilization - trends
Female
Fibrinolytic Agents - administration & dosage
Humans
Internal Medicine
Male
Medication Adherence - statistics & numerical data
Medicine
Medicine & Public Health
Middle Aged
Netherlands
Pharmacy
Polypharmacy
Research Article
Retrospective Studies
Risk Factors
Sex Factors
Vitamin K
Netherlands
Adherence
NOACs
Netherlands
DOACs
Drug use patterns
Non-vitamin K oral anticoagulants
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Summary:Background Non-vitamin K oral anticoagulants (NOACs) became available in the Netherlands in 2008, providing another antithrombotic treatment besides vitamin K antagonists (VKAs) and antiplatelet agents (APAs). Objective To describe the patterns of antithrombotic drug use between 2008 and 2013 by examination of dispensing data form community pharmacies in the Netherlands; to determine the concomitant use of NOACs with VKAs and APAs and switching between the drug classes; and to compare adherence to NOACs with adherence to APAs. Setting An observational retrospective study was conducted using routinely collected dispensing data from Dutch community pharmacies. Methods For each calendar year, the numbers of NOAC, VKA, and APA users were calculated. Adherence was determined for NOACs and APAs by the percentage of days covered by medication (PDC). Information on the prescribed daily dose of VKAs was unavailable. Main outcome measures Comparison of age, sex, and co-medications of users of the three drug classes; concomitant use of different antithrombotic drug classes and switching between these in each year; and mean PDC and percentages of all users with a PDC above 80 %. Results NOAC use increased during the study period to 29,687 users in 2013. In that year there were 484,024 VKA users and 1313,032 APA users. Compared with users of VKAs, NOAC users were slightly younger and more frequently used antiarrhythmic drugs and beta blockers as co-medications. Substantial numbers of patients were dispensed potentially harmful combinations in 2013: 820 subjects were dispensed NOACs together with VKAs, and 684 subjects were dispensed NOACs, VKAs, and APAs concomitantly. Mean adherence to NOACs was 84.2 % compared with 87.3 % to APA. One in four NOAC users had a PDC lower than 80 % compared with one in five APA users. Conclusion Our findings show increasing use of NOACs by outpatients. The number of patients taking potentially harmful combinations of antithrombotic drugs was substantial. Adherence to NOACs in daily practice may be suboptimal to prevent thrombotic events.
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ISSN:2210-7703
2210-7711
DOI:10.1007/s11096-015-0174-4