Prescribing of low-dose rivaroxaban in patients with atherosclerotic cardiovascular disease in the United Kingdom and the Netherlands

Nicholas B Hunt; Romin Pajouheshnia; Allan Salih; Sander van Doorn; Patrick C Souverein; Marloes T Bazelier; Olaf H Klungel; Helga Gardarsdottir

doi:10.1111/bcp.15708

Prescribing of low-dose rivaroxaban in patients with atherosclerotic cardiovascular disease in the United Kingdom and the Netherlands

Nicholas B Hunt, Romin Pajouheshnia, Allan Salih, Sander van Doorn, Patrick C Souverein, Marloes T Bazelier, Olaf H Klungel, Helga Gardarsdottir

Uppsala University

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Aims: Low-dose rivaroxaban has been indicated for the management of atherosclerotic cardiovascular disease (ASCVD) after recent (2019-2020) updates to European guidelines. We aimed to describe prescription trends of low-dose rivaroxaban in ASCVD patients over the period 2015-2022 in two European countries, to compare the trends before and after guideline changes, and to determine the characteristics of users. Methods: In a cross-sectional interrupted time series analysis, utilization of low-dose rivaroxaban (2.5 mg, twice daily) was measured in Clinical Practice Research Datalink Aurum (United Kingdom [UK]) and the PHARMO Database Network (the Netherlands) from 1 January 2015 to 28 February 2022 in patients with an ASCVD diagnosis. Incidence rates (IRs) and incidence rate ratios (IRRs) of new use (within 182 days) compared to the reference period, 2015-2018, were calculated. Age, sex and comorbidities of users were compared to those of nonusers. Results: In the UK, from 721 271 eligible subjects the IR of new use of low-dose rivaroxaban in the period 2015-2018, before guideline changes, was 12.4 per 100 000 person-years and after guideline changes in 2020-2022 was 124.0 (IRR 10.0, 95% confidence interval [CI] 8.5, 11.8). In the Netherlands from 394 851 subjects, the IR in 2015-2018 was 2.4 per 100 000 person-years and in 2020 was 16.3 (IRR 6.7, 95% CI 4.0, 11.4). Users were younger (UK mean difference [MD] −6.1 years, Netherlands −2.4 years; P <.05) and more likely to be male (UK difference 11.5%, Netherlands 13.4%; P <.001) than nonusers. Conclusions: There was a statistically significant increase in the use of low-dose rivaroxaban for the management of ASCVD after guideline changes in the UK and the Netherlands. There were international differences, but low-dose rivaroxaban has not been put into widespread practice.

Original language	English
Pages (from-to)	2263-2271
Number of pages	9
Journal	British Journal of Clinical Pharmacology
Volume	89
Issue number	7
Early online date	8 Mar 2023
DOIs	https://doi.org/10.1111/bcp.15708
Publication status	Published - Jul 2023

Bibliographical note

Funding Information:
Earlier work on non‐vitamin K antagonist oral anticoagulants (NOACs) was conducted by the Pharmacoepidemiology and Pharmacovigilance Research Network, which is a public academic partnership coordinated by Utrecht University, the Netherlands. The project received support from the European Medicines Agency under the Framework service contract nr EMA/2015/27/PH (EU PAS 16014).

Publisher Copyright:
© 2023 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

Keywords

anticoagulation
myocardial ischemia
peripheral vascular diseases
rivaroxaban
utilization

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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Brit J Clinical Pharma - 2023 - Hunt - Prescribing of low‐dose rivaroxaban in patients with atherosclerotic cardiovascularFinal published version, 720 KBLicence: CC BY-NC-ND

Cite this

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title = "Prescribing of low-dose rivaroxaban in patients with atherosclerotic cardiovascular disease in the United Kingdom and the Netherlands",

abstract = "Aims: Low-dose rivaroxaban has been indicated for the management of atherosclerotic cardiovascular disease (ASCVD) after recent (2019-2020) updates to European guidelines. We aimed to describe prescription trends of low-dose rivaroxaban in ASCVD patients over the period 2015-2022 in two European countries, to compare the trends before and after guideline changes, and to determine the characteristics of users. Methods: In a cross-sectional interrupted time series analysis, utilization of low-dose rivaroxaban (2.5 mg, twice daily) was measured in Clinical Practice Research Datalink Aurum (United Kingdom [UK]) and the PHARMO Database Network (the Netherlands) from 1 January 2015 to 28 February 2022 in patients with an ASCVD diagnosis. Incidence rates (IRs) and incidence rate ratios (IRRs) of new use (within 182 days) compared to the reference period, 2015-2018, were calculated. Age, sex and comorbidities of users were compared to those of nonusers. Results: In the UK, from 721 271 eligible subjects the IR of new use of low-dose rivaroxaban in the period 2015-2018, before guideline changes, was 12.4 per 100 000 person-years and after guideline changes in 2020-2022 was 124.0 (IRR 10.0, 95% confidence interval [CI] 8.5, 11.8). In the Netherlands from 394 851 subjects, the IR in 2015-2018 was 2.4 per 100 000 person-years and in 2020 was 16.3 (IRR 6.7, 95% CI 4.0, 11.4). Users were younger (UK mean difference [MD] −6.1 years, Netherlands −2.4 years; P <.05) and more likely to be male (UK difference 11.5%, Netherlands 13.4%; P <.001) than nonusers. Conclusions: There was a statistically significant increase in the use of low-dose rivaroxaban for the management of ASCVD after guideline changes in the UK and the Netherlands. There were international differences, but low-dose rivaroxaban has not been put into widespread practice.",

keywords = "anticoagulation, myocardial ischemia, peripheral vascular diseases, rivaroxaban, utilization",

author = "Hunt, {Nicholas B} and Romin Pajouheshnia and Allan Salih and {van Doorn}, Sander and Souverein, {Patrick C} and Bazelier, {Marloes T} and Klungel, {Olaf H} and Helga Gardarsdottir",

note = "Funding Information: Earlier work on non‐vitamin K antagonist oral anticoagulants (NOACs) was conducted by the Pharmacoepidemiology and Pharmacovigilance Research Network, which is a public academic partnership coordinated by Utrecht University, the Netherlands. The project received support from the European Medicines Agency under the Framework service contract nr EMA/2015/27/PH (EU PAS 16014). Publisher Copyright: {\textcopyright} 2023 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.",

year = "2023",

month = jul,

doi = "10.1111/bcp.15708",

language = "English",

volume = "89",

pages = "2263--2271",

journal = "British Journal of Clinical Pharmacology",

issn = "0306-5251",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "7",

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T1 - Prescribing of low-dose rivaroxaban in patients with atherosclerotic cardiovascular disease in the United Kingdom and the Netherlands

AU - Hunt, Nicholas B

AU - Pajouheshnia, Romin

AU - Salih, Allan

AU - van Doorn, Sander

AU - Souverein, Patrick C

AU - Bazelier, Marloes T

AU - Klungel, Olaf H

AU - Gardarsdottir, Helga

N1 - Funding Information: Earlier work on non‐vitamin K antagonist oral anticoagulants (NOACs) was conducted by the Pharmacoepidemiology and Pharmacovigilance Research Network, which is a public academic partnership coordinated by Utrecht University, the Netherlands. The project received support from the European Medicines Agency under the Framework service contract nr EMA/2015/27/PH (EU PAS 16014). Publisher Copyright: © 2023 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

PY - 2023/7

Y1 - 2023/7

N2 - Aims: Low-dose rivaroxaban has been indicated for the management of atherosclerotic cardiovascular disease (ASCVD) after recent (2019-2020) updates to European guidelines. We aimed to describe prescription trends of low-dose rivaroxaban in ASCVD patients over the period 2015-2022 in two European countries, to compare the trends before and after guideline changes, and to determine the characteristics of users. Methods: In a cross-sectional interrupted time series analysis, utilization of low-dose rivaroxaban (2.5 mg, twice daily) was measured in Clinical Practice Research Datalink Aurum (United Kingdom [UK]) and the PHARMO Database Network (the Netherlands) from 1 January 2015 to 28 February 2022 in patients with an ASCVD diagnosis. Incidence rates (IRs) and incidence rate ratios (IRRs) of new use (within 182 days) compared to the reference period, 2015-2018, were calculated. Age, sex and comorbidities of users were compared to those of nonusers. Results: In the UK, from 721 271 eligible subjects the IR of new use of low-dose rivaroxaban in the period 2015-2018, before guideline changes, was 12.4 per 100 000 person-years and after guideline changes in 2020-2022 was 124.0 (IRR 10.0, 95% confidence interval [CI] 8.5, 11.8). In the Netherlands from 394 851 subjects, the IR in 2015-2018 was 2.4 per 100 000 person-years and in 2020 was 16.3 (IRR 6.7, 95% CI 4.0, 11.4). Users were younger (UK mean difference [MD] −6.1 years, Netherlands −2.4 years; P <.05) and more likely to be male (UK difference 11.5%, Netherlands 13.4%; P <.001) than nonusers. Conclusions: There was a statistically significant increase in the use of low-dose rivaroxaban for the management of ASCVD after guideline changes in the UK and the Netherlands. There were international differences, but low-dose rivaroxaban has not been put into widespread practice.

AB - Aims: Low-dose rivaroxaban has been indicated for the management of atherosclerotic cardiovascular disease (ASCVD) after recent (2019-2020) updates to European guidelines. We aimed to describe prescription trends of low-dose rivaroxaban in ASCVD patients over the period 2015-2022 in two European countries, to compare the trends before and after guideline changes, and to determine the characteristics of users. Methods: In a cross-sectional interrupted time series analysis, utilization of low-dose rivaroxaban (2.5 mg, twice daily) was measured in Clinical Practice Research Datalink Aurum (United Kingdom [UK]) and the PHARMO Database Network (the Netherlands) from 1 January 2015 to 28 February 2022 in patients with an ASCVD diagnosis. Incidence rates (IRs) and incidence rate ratios (IRRs) of new use (within 182 days) compared to the reference period, 2015-2018, were calculated. Age, sex and comorbidities of users were compared to those of nonusers. Results: In the UK, from 721 271 eligible subjects the IR of new use of low-dose rivaroxaban in the period 2015-2018, before guideline changes, was 12.4 per 100 000 person-years and after guideline changes in 2020-2022 was 124.0 (IRR 10.0, 95% confidence interval [CI] 8.5, 11.8). In the Netherlands from 394 851 subjects, the IR in 2015-2018 was 2.4 per 100 000 person-years and in 2020 was 16.3 (IRR 6.7, 95% CI 4.0, 11.4). Users were younger (UK mean difference [MD] −6.1 years, Netherlands −2.4 years; P <.05) and more likely to be male (UK difference 11.5%, Netherlands 13.4%; P <.001) than nonusers. Conclusions: There was a statistically significant increase in the use of low-dose rivaroxaban for the management of ASCVD after guideline changes in the UK and the Netherlands. There were international differences, but low-dose rivaroxaban has not been put into widespread practice.

KW - anticoagulation

KW - myocardial ischemia

KW - peripheral vascular diseases

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KW - utilization

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Prescribing of low-dose rivaroxaban in patients with atherosclerotic cardiovascular disease in the United Kingdom and the Netherlands

Abstract

Bibliographical note

Keywords

UN SDGs

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