Clinician Trends in Prescribing Direct Oral Anticoagulants for US Medicare Beneficiaries

• DOI: 10.1001/jamanetworkopen.2021.37288
• Publication Date: 2021-12-06T16:01:33Z
• Authors: Kevin M. Wheelock; Joseph S. Ross; Karthik Murugiah; Zhenqiu Lin; Harlan M. Krumholz; Rohan Khera
• Keywords: Oral anticoagulant

Contemporary national clinical practice guidelines recommend direct-acting oral anticoagulants (DOACs) as the first-line anticoagulant strategy over warfarin for most indications, especially among older individuals with an elevated bleeding risk.To evaluate prescribing and DOAC uptake by US clinicians in Medicare population.This retrospective cohort study included all more than 10 prescription claims, who were Provider Utilization Payment Data (2013-2018). analyses conducted between October 2020 2021.DOAC 2013.Clinicians categorized based on 2013 solely warfarin, DOAC, or both, their temporal trajectories of proportionate use examined.The analysis 325 666 unique prescriptions 2018 (26 620 [8.2%] cardiologists, 85 563 [26.3%] internal medicine physicians, 84 369 [25.9%] family 81 161 [24.9%] advanced clinicians, including nurse practitioners physician assistants). In 2013, 91 837 prescribers, 54 501 (59.3%) prescribed only 1918 (2.1%) a 35 418 (38.6%) both. During period, number DOACs increased, but 19% continued to prescribe 2018. While 359 cardiologists (1.6%) warfarin-only 414 (20.0%) 6296 (12.6%) physicians also respectively. Clinicians had lower throughout compared which represents median (IQR) 41.9% (20.3%-61.9%) vs 67.0% (49.9%-82.8%) prescribers.Despite increase beneficiaries, many this predominant instead DOACs. There is need address barriers these medications realize potential benefits patients.