Impact of the COVID-19 pandemic on England’s national prescriptions of direct-acting oral anticoagulants (DOACs): An interrupted time series analysis

Abstract

Background: Direct-acting oral anticoagulants (DOACs) were developed as an alternative to warfarin to treat and prevent thromboembolism, including stroke prevention in non-valvular atrial fibrillation patients. The COVID-19 pandemic effects on patients and healthcare could increase the risk of stroke due to nonadherence/suboptimal dosing of DOACs and the risk of bleeding as an adverse effect. Objective: To observe how the COVID-19 pandemic impacted DOAC prescription trends in England’s community settings. Methods: Descriptive and interrupted time series (ITS) analyses were conducted to examine the prescription patterns of DOACs (dabigatran, rivaroxaban, apixaban and edoxaban) and warfarin for primary care patients in the English Prescribing Dataset from January 2019 to February 2021, with March 2020 considered as the pandemic cut-off point. Results: There was a 19% increase in mean DOAC prescription volume during the pandemic, while mean warfarin prescriptions decreased by 20%. ITS modelling showed an increase in DOAC prescription volume level in March 2020 (+7 million items, p = 0.008). The upward trend in DOAC prescriptions slowed during the pandemic (-427,000 items, p = 0.007). Apixaban was the most frequently used DOAC and had the greatest change in level in March 2020 (+5 million items, p = 0.010). The mean monthly combined cost of DOACs and warfarin was higher during the pandemic. DOAC prescription trends were consistent across England’s regions. Conclusion: The potential clinical and logistical consequences of the significant changes in DOAC prescription trends may warrant further investigations and interventions to identify contributing factors and mitigate avoidable risks.