Trends in use of Direct Oral Anticoagulants and Warfarin in Atrial Fibrillation Patients

  • Lili Musnelina Faculty of Pharmacy, National Institute of Science and Technology, South Jakarta, DKI Jakarta, 12620, Indonesia
  • Fitri Handayani Faculty of Pharmacy, National Institute of Science and Technology, South Jakarta, DKI Jakarta, 12620, Indonesia
  • Thanh - Hoa Vo School of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
  • Jenny Pontoan Faculty of Pharmacy, National Institute of Science and Technology, South Jakarta, DKI Jakarta, 12620, Indonesia

Abstract

Treatments used in atrial fibrillation therapy, such as those of anticoagulants, consist of vitamin K antagonists (warfarin) and direct oral anticoagulants (dabigatran, apixaban, rivaroxaban, and edoxaban). The use of warfarin requires regular monitoring of prothrombin time (PT) and international normalised ratio (INR). The therapeutic dose range is narrow, but the price is cheaper. Oral anticoagulants are directed, the incidence of major bleeding is lower, ease of use, food and drug interactions are minor, the half-life is shorter, and there is a lack of laboratory monitoring needs. Based on this problem, researchers conducted a study to determine the trend of using warfarin and oral anticoagulants in patients with atrial fibrillation at a public hospital in Jakarta. This study uses a qualitative approach, with longitudinal methods and retrospective data using outpatient medical records for the period 2014 to 2018. The trend of using warfarin anticoagulants decreased from 82.3% in 2014 to 62% in 2016, while oral anticoagulants were reduced. Direct oral anticoagulants are rivaroxaban and dabigatran, which are more widely used than apixaban, and edoxaban; no data on their use has been obtained. The opposite was true from 2017 to 2018, when the use of warfarin increased and caused a decrease in the use of direct oral anticoagulants. This research is expected to contribute to various parties, both health practitioners and academics, in terms of selecting therapies for atrial fibrillation.

References

1. Hartono B, Hanafy DA, Yugo D, Maharani E, Antara IMPS, Raharjo SB. Pedoman tatalaksana fibrilasi atrium non-valvular. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI). Edisi Kedua, Cetakan Pertama. Trans Medical International. 2019. p. xviii–144.

2. Centers for Disease Control and Prevention. Atrial Fibrillation. 2023. p. 3–6.

3. Xu X, Wei S, Ma C, Luo K, Zhang L, Liu C. Atrial fibrillation beat identification using the combination of modified frequency slice wavelet transform and con¬volutional neural networks. J Healthc Eng. 2018:1-8.

4. World Health Organization. Cardiovascular diseases (CVDs). 2021. p. 1–5.

5. Lippi G, Mattiuzzi C, Cervellin G, Favaloro EJ. Direct oral anticoagulants: analysis of worldwide use and popularity using google trends. Ann Transl Med. 2017;5(16):1–8.

6. Alquwaizani M, Buckley L, Adams C, Fanikos J. Anticoagulants: a review of the pharmacology, dosing, and complications. Curr Emerg Hosp Med Rep. 2013;1(2):83–97.

7. Patel S, Singh R, Preuss C V, Patel N. Warfarin. Vol. 1. StatPearls; 2022. p. 1–7.

8. Shendre A, Parmar GM, Dillon C, Beasley TM, Limdi NA. Influence of age on warfarin dose, anticoagulation control, and risk of hemorrhage. Pharmacotherapy. 2018;38(6):588–96.

9. Suriapranata IM, Tjong WY, Wang T, Utama A, Raharjo SB, Yuniadi Y, Tai SSW. Genetic factors associated with patient-specific warfarin dose in ethnic Indonesians. BMC Med Genet. 2011;12(80):2-9.

10. Ten Cate H, McHenskens Y, Lancé MD. Practical guidance on the use of laboratory testing in the management of bleeding in patients receiving direct oral anticoagulants. Vasc Health Risk Manag. 2017;13:457–67.

11. Myers K, Lyden A. A review on the new and old anticoagulants. Orthop Nurs. 2019;38(1):43–52.

12. Adeyana S, Haryadi H, Wijaya C. Hubungan kejadian fibrilasi atrium dengan diameter atrium kiri pada fibrilasi atrium valvular dan fibrilasi atrium non-valvular di RSUD Arifin Achmad. J Ilmu Kedokt. 2017;11(1):31–8.

13. Dharma Rao V, Rajaneesh Reddy M, Srikanth K, Raj Kumar Prakash B, Satya Prasad A, Guru Prasad SS. To study the prevalence and clinical profile of chronic atrial fibrillation in hospitalized patents. Nitte Univ J Heal Sci. 2014;4(2):17–20.

14. Sankaranarayanan R, Kirkwood G, Dibb K, Garratt CJ. Comparison of atrial fibrillation in the young versus that in the elderly: A review. Cardiol Res Pract. 2013;976976:1-16.

15. Mendrofa DE, Suryawati C. Analisis Pengelolaan Obat Pasien BPJS Di Instalasi Farmasi Rumah Sakit Panti Wilasa Citarum Semarang. J Manaj Kesehat Indones. 2016;4(3):214–21.

16. Kementerian Kesehatan Republik Indonesia. KEPMENKES Nomor 328/MENKES/SK/VIII/2013 ten¬tang Formularium Nasional. 2013;53(9):100.

17. Unger EF. Atrial fibrillation and new oral anticoagulant drugs. 2015;2015:1–3.

18. Zimetbaum Peter MD. DOACs now recommended over warfarin to prevent blood clots in people with atrial fibrillation. Harvard Heal Publ. 2019;1–13.

19. Alalwan AA, Voils SA, Hartzema AG. Trends in utilization of warfarin and direct oral anticoagulants in older adult patients with atrial fibrillation. Am J Heal Pharm. 2017;74(16):1237–44.

20. Ikeda T, Yasaka M, Kida M, Imura M. A survey of reasons for continuing warfarin therapy in the era of direct oral anticoagulants in Japanese patients with atrial fibrillation: the SELECT study. Patient Prefer Adherence. 2018;12:135–43.

21. Coyle D, Coyle K, Cameron C, Lee K, Kelly S, Steiner S, Wells GA. Cost-effectiveness of new oral anticoagulants compared with warfarin in preventing stroke and other cardiovascular events in patients with atrial fibrillation. Value Heal. 2013;16(4):498–506.

22. Yuniadi Y, Hanafy DA, Rahardjo SB, Tondas AE, Ma¬harani E, Hermanto DY, Munawar M. 2014 Indonesian Heart Association Guidelines of Management of Atrial Fibrillation. Indones J Cardiol. 2015;35(2):102–33.

23. Erlanda W, Karani Y. Penggunaan antikoagulan pada penyakit ginjal kronik. J Kesehat Andalas. 2018;7(Sup-plement 2):168-75.

24. Khairunnisa, Dini, Sari, Ika Puspita, dan Gofir A. The corelation between dose and duration in warfarin administration. J Manaj dan Pelayanan Farm. 2013;3(4):269–72.

25. Furdiyanti NH. Evaluasi dosis warfarin dan hasil terapi pada pasien rawat jalan. J Manaj dan Pelayanan Farm. 2014;4(3):176–80.

26. Sikorska J, Uprichard J. Direct oral anticoagulants: A quick guide. Eur Cardiol Rev. 2017;12(1):40–5. Doi: 10.15420/ecr.2017:11:2.

27. Vimalesvaran K, Dockrill SJ, Gorog DA. Role of rivaroxaban in the management of atrial fibrillation: Insights from clinical practice. Vasc Health Risk Manag. 2018;14:13–21.

28. Leung TS, Fradette M, Thompson A, Koshman SL. Dabigatran in atrial fibrillation: new kid on the block. Can Pharm J. 2012;145(2):83–8

29. Ahmad Y, Lip GYH. Anticoagulation in Atrial Fibrillation. Arrhythm Electrophysiol Rev. 2012;1(1):12–6.

30. Krisnayanti MW. Penggunaan antikoagulan oral baru pada fibrilasi atrium. J Farm Udayana. 2019;8(1):1.

31. Irawati S. Apixaban: antikoagulan oral baru- penghambat spesifik faktor Xa. Medikamen. 2014;(22):1.
Published
2023-10-19
How to Cite
MUSNELINA, Lili et al. Trends in use of Direct Oral Anticoagulants and Warfarin in Atrial Fibrillation Patients. JURNAL ILMU KEFARMASIAN INDONESIA, [S.l.], v. 21, n. 2, p. 266-272, oct. 2023. ISSN 2614-6495. Available at: <http://jifi.farmasi.univpancasila.ac.id/index.php/jifi/article/view/1475>. Date accessed: 27 apr. 2024. doi: https://doi.org/10.35814/jifi.v21i2.1475.
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Articles