Objective Antithrombotic drugs are widely used in the prevention and treatment of cardiovascular diseases; yet, nationwide long-term usage trends remain unexplored. We examined long-term trends in the use of antithrombotic drugs in Denmark.
Methods Using nationwide prescription data, we obtained information on primary care use of antiplatelet drugs, vitamin K antagonists (VKA), non-vitamin K antagonist oral anticoagulants (NOAC), heparins and fondaparinux during 1999–2014.
Results During the 16-year period, the use of antithrombotic drugs per 1000 inhabitants/day increased from 64 to 96 defined daily doses (DDD), and the prevalence proportion of users doubled from 5.1% to 9.6% of the Danish population. From 1999 to 2014, there was an increased use of both antiplatelet drugs (from 60 to 79 DDD per 1000 inhabitants/day) and VKA (from 4 to 9 DDD per 1000 inhabitants/day). NOAC was marketed in 2008 and had an abrupt rise in use to 8 DDD per 1000 inhabitants/day in 2014. The use of heparins and fondaparinux increased slightly during the study period (from 0 to 0.6 DDD per 1000 inhabitants/day). Hospital use of antithrombotic drugs also increased during the study period, but constituted a minor part of the total use (4 DDD per 1000 inhabitants/day in 2014).
Conclusions Considerable changes have occurred in the use of antithrombotic drugs during the past 16 years, including the introduction of several new and increasingly used treatment modalities such as NOAC. The trends in use of individual drugs correlate well with the publication of landmark studies.
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Contributors KA and MS conceived the idea and designed the study. KA ascertained the statistical results. KA, ELG, JS, ML and MS interpreted the data and reviewed the literature. KA drafted the first manuscript. ELG, JS, ML and MS critically reviewed the manuscript and approved the final version for submission. MS has the overall responsibility for the accuracy of the data and the manuscript.
Funding Funding was provided through the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Competing interests ELG has received speaker honoraria from AstraZeneca, Baxter, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb and Pfizer and has participated in advisory board meetings for AstraZeneca, Bayer, Boehringer Ingelheim and Bristol-Myers Squibb.
Ethics approval Approval from an ethical committee was not required for this study according to Danish law.
Provenance and peer review Not commissioned; externally peer reviewed.