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Uptake of novel oral anticoagulants in Australia

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Clinical trials have shown that novel oral anticoagulants (NOACs) are as efficacious as warfarin in reducing the risk of stroke in patients with atrial fibrillation.13 However, concerns regarding efficacy and safety in real-world populations remain, particularly in patients aged 75 years and older and those with comorbid conditions.4 Three NOACs — dabigatran, rivaroxaban and apixaban — were listed by the Pharmaceutical Benefits Scheme in 2013, but there is little information about their uptake in clinical practice in Australia.

We conducted a retrospective observational study to examine overall use and initiation of oral anticoagulants, and the characteristics of patients for whom they are prescribed. We used administrative claims data from the Australian Government Department of Veterans’ Affairs for patients who were full entitlement holders (ethics approval E010/010). Monthly rates of NOAC and warfarin use were calculated for the period 1 January 2012 – 31 August 2014, and numbers of veterans initiated each month on low-dose and high-dose NOACs were calculated for the period 1 September 2013 – 31 August 2014. Clinical characteristics of new users of NOACs or warfarin (no use of warfarin in the previous 12 months) were compared using χ2 or Wilcoxon rank sum tests.