Influence of Direct Oral Anticoagulants on Rates of Oral Anticoagulation for Atrial Fibrillation

Oral anticoagulation (OAC) with warfarin is underused for atrial fibrillation (AF). The availability of direct oral anticoagulants (DOACs) may improve overall OAC rates in AF patients, but a large-scale evaluation of their effects has not been conducted.This study assessed the effect of DOAC availability on overall OAC rates for nonvalvular AF.Between April 1, 2008 and September 30, 2014, we identified 655,000 patients with nonvalvular AF and a CHAOverall OAC rates increased from 52.4% to 60.7% among eligible AF patients (p for trend 0.01). Warfarin use decreased from 52.4% to 34.8% (p for trend 0.01), and DOAC use increased from 0% to 25.8% (p for trend 0.01). An increasing CHAIntroduction of DOACs in routine practice was associated with improved rates of overall OAC use for AF, but significant gaps remain. In addition, there is significant practice-level variation in OAC and DOAC use.