Current trends in the use of anticoagulant pharmacotherapy in the United Kingdom are changes on the horizon?

ABSTRACT

Introduction

Effective stroke prevention with oral anticoagulation (OAC) reduces the risk of stroke and death among patients with atrial fibrillation (AF). For most patients with AF, treatment options include vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOACs). NOACs have been introduced as an alternative to VKAs, and their use has been steadily increasing in the United Kingdom and Europe over a decade. In randomized clinical trials, NOACs had a favorable risk-benefit profile as compared to warfarin. However, there is a concern about their long-term safety in clinical practice, especially in high-risk patients. There have been a number of registries and surveys based on the real-world patients with AF which has been conducted and published, providing data on contemporary AF management.

Areas covered

In this narrative review, the authors discuss current trends in the use of OAC in the United Kingdom and Europe, considering the potential directions for future anticoagulant therapy in patients with AF.

Expert opinion

The increasing prevalence of AF and AF-related comorbidities proves the need for comprehensive prevention and management strategies. The challenge is the optimization of therapy for each patient. However, there are still gaps in optimal stroke prevention, and the mortality rates remain high in patients with AF.

KEYWORDS:

• Atrial fibrillation
• bleeding
• non-vitamin K antagonists
• oral anticoagulation
• stroke prevention
• vitamin K antagonists

Article highlights

• Effective stroke prevention with oral anticoagulation reduces the risk of stroke and death among patients with atrial fibrillation (AF); and the current treatment options include vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOACs).

• The trends from Europe and the United Kingdom showed a move toward an increase in guideline-based OAC prescribing to prevent strokes in patients with AF, mostly driven by an uptake in the use of NOACs.

• Despite the increase in the use of OAC over the last decade, there are still gaps in optimal stroke prevention, and the risk of all-cause death remains high in patients with AF.

• Highly individualized management is needed, incorporating patient values and preferences.

Declaration of interest

GYH Lip declares having consultancy work for Bayer/Janssen Pharmaceuticals, Bristol-Myers Squibb/Pfizer Inc, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi Sankyo. He has also served as a speaker for Bayer, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim and Daiichi Sankyo. No fees have been directly received. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.