Patterns in anticoagulant utilization in the Czech Republic during 2007–2017

  • J. Maly
  • S. Dvorackova
  • E. Zimcikova
  • A. A. Kubena
  • J. Kolar
  • J. Vlcek
  • M. Penka
  • K. Mala-LadovaEmail author


Direct oral anticoagulants (DOACs) have gradually entered the Czech market as alternatives to vitamin K antagonists and parenteral anticoagulants since 2008. Considering the eventual changes, the aim was to evaluate drug use and expenditure patterns on anticoagulants in the Czech Republic. A retrospective utilization study was conducted retrieving data from the State Institute for Drug Control database, including reports on drug supplies from distributors with anatomical therapeutic chemical classification (ATC) codes B01AA, B01AB, B01AE, B01AF, and B01AX. The utilization on national level was expressed as the ratio of the number of defined daily doses per 1000 inhabitants per day (DDD/TID). Expenditures on all anticoagulants were also assessed. Data was analyzed using PASW (version 18.0). Between January 2007 and December 2017, the national anticoagulant utilization rate increased continuously from 14.15 to 27.67 DDD/TID. The use of DOACs was 0.002 DDD/TID in 2008, increased to 6.04 DDD/TID in 2017. Warfarin utilization, after a small decrease in 2008, has shown nearly stable levels in the recent years (70.9% of all anticoagulants; mean 11.55 DDD/TID over the last 5 years), while its increase was halted by the spread of DOACs utilization (p < 0.05). In 2017, over half of the expenditures (51.1%) were due to oral anticoagulants, whereof 47.6% was related to DOACs. The results reflected a growing utilization and increasing costs of all anticoagulants, especially in DOACs at the expense of warfarin. Still, additional information regarding patient persistence and prescribing patterns is needed for a better understanding of oral anticoagulant utilization.


Anticoagulants Drug utilization Warfarin DOAC Czech Republic 



The study was supported by Charles University (Project SVV 260 417). The authors express their grateful thanks especially to Dr. Eva Jirsova and Dr. Kamil Kalousek from the State Institute for Drug Control (SUKL) for providing the national data about drug utilization.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

11239_2019_1806_MOESM1_ESM.tif (605 kb)
Supplementary material 1 (TIF 605 KB)


  1. 1.
    Kirley K, Qato DM, Kornfield R, Stafford RS, Alexander GC (2012) National trends in oral anticoagulant use in the United States, 2007 to 2011. Circ Cardiovasc Qual Outcomes 5(5):615–621CrossRefGoogle Scholar
  2. 2.
    Barnes GD, Lucas E, Alexander GC, Goldberger ZD (2015) National trends in ambulatory oral anticoagulant use. Am J Med 128(12):1300–1305CrossRefGoogle Scholar
  3. 3.
    Nutescu EA, Spinler SA, Dager WE, Bussey HI (2004) Transitioning from traditional to novel anticoagulants: the impact of oral direct thrombin inhibitors on anticoagulation management. Pharmacotherapy 24(10):199–202CrossRefGoogle Scholar
  4. 4.
    Alquwaizani M, Buckley L, Adams C, Fanikos J (2013) Anticoagulants: a review of the pharmacology, dosing, and complications. Curr Emerg Hosp Med Rep 1(2):83–97CrossRefGoogle Scholar
  5. 5.
    Elewa H, Alhaddad A, Al-Rawi S, Nounou A, Mahmoud H, Singh R (2017) Trends in oral anticoagulant use in Qatar: a 5-year experience. J Thromb Thrombolysis 43(3):411–416CrossRefGoogle Scholar
  6. 6.
    Hanemaaijer S, Sodihardjo F, Horikx A, Wensing M, De Smet PAGM, Bouvy ML, Teichert M (2015) Trends in antithrombotic drug use and adherence to non-vitamin K oral anticoagulants in the Netherlands. Int J Clin Pharm 37(6):1128–1135CrossRefGoogle Scholar
  7. 7.
    Weitz JI, Semchuk W, Turpie AGG, Fisher WD, Kong C, Ciaccia A, Cairns JA (2015) Trends in prescribing oral anticoagulants in Canada, 2008–2014. Clin Ther 37(11):2506–2514CrossRefGoogle Scholar
  8. 8.
    Olesen JB, Sorensen R, Hansen ML et al (2015) Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naive atrial fibrillation patients: Danish nationwide descriptive data 2011–2013. Europace 17(2):187–193CrossRefGoogle Scholar
  9. 9.
    Heidbuchel H, Verhamme P, Alings M et al (2015) Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 17(10):1467–1507CrossRefGoogle Scholar
  10. 10.
    State Institute for Drug Control (2018) Supplies of medicinal products. Accessed 1 June 2018
  11. 11.
    Health System in Transition (2015) Czech Republic: Health System review. Accessed 22 Dec 2018
  12. 12.
    WHO Collaborating Centre for Drug Statistics Methodology (2012) Guidelines for ATC classification and DDD assignment 2013. Oslo. Accessed 7 June 2018
  13. 13.
    Kirchhof P, Benussi S, Kotecha D et al (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37(38):2893–2962CrossRefGoogle Scholar
  14. 14.
    Di Nisio M, Van Es N, Büller HR (2016) Deep vein thrombosis and pulmonary embolism. Lancet 388(10063):3060–3073CrossRefGoogle Scholar
  15. 15.
    Goldhaber SZ, Bounameaux H (2012) Pulmonary embolism and deep vein thrombosis. Lancet 379(9828):1835–1846CrossRefGoogle Scholar
  16. 16.
    Czech Society for Thrombosis and Hemostasis (2018) Guidelines. Accessed 29 Oct 2018
  17. 17.
    Xu Y, Holbrook AM, Simpson CS, Dowlatshahi D, Johnson AP (2013) Prescribing patterns of novel oral anticoagulants following regulatory approval for atrial fibrillation in Ontario, Canada: a population-based descriptive analysis. CMAJ Open 1(3):E115–E119CrossRefGoogle Scholar
  18. 18.
    Loo SY, Dell’Aniello S, Huiart L, Renoux C (2017) Trends in the prescription of novel oral anticoagulants in UK primary care. Br J Clin Pharmacol 83(9):2096–2106CrossRefGoogle Scholar
  19. 19.
    Wood M, Shaw P (2015) Pradaxa-induced esophageal ulcer. BMJ Case Rep. Google Scholar
  20. 20.
    Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus Warfarin in patients with atrial fibrillation. N Engl J Med 361(12):1139–1151CrossRefGoogle Scholar
  21. 21.
    Graham DJ, Reichman ME, Wernecke M et al (2015) Cardiovascular, bleeding, and mortality risks in elderly Medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation. Circulation 131(2):157–164CrossRefGoogle Scholar
  22. 22.
    Kundu A, Sardar P, Chatterjee S et al (2016) Minimizing the risk of bleeding with NOACs in the elderly. Drugs Aging 33(7):491–500CrossRefGoogle Scholar
  23. 23.
    Pottegård A, Grove EL, Hellfritzsch M (2018) Use of direct oral anticoagulants in the first year after market entry of edoxaban: a Danish nationwide drug utilization study. Pharmacoepidemiol Drug Saf 27(2):174–181CrossRefGoogle Scholar
  24. 24.
    Rossi AP, Facchinetti R, Ferrari E et al (2018) Predictors of self-reported adherence to direct oral anticoagulation in a population of elderly men and women with non-valvular atrial fibrillation. J Thromb Thrombolysis. Google Scholar
  25. 25.
    Dvorackova S, Ladova K, Maly J, Kolar J, Penka M (2017) Medication adherence to non-vitamin K antagonist oral anticoagulants at non-valvular atrial fibrillation—the literature review. Vnitr lek 63(10):633–639Google Scholar
  26. 26.
    Protty MB, Hayes J (2017) Dawn of the direct-acting oral anticoagulants: trends in oral anticoagulant prescribing in Wales 2009–2015. J Clin Pharm Ther 42(2):132–134CrossRefGoogle Scholar
  27. 27.
    Arjakse J, Orav L, Maradi T (2015) Consumption of antithromotic drugs in North Estonia medical centre and Estonia from 2009 to 2013. Int J Clin Pharm 37(1):196. Abstract Google Scholar
  28. 28.
    State Institute for Drug Control (2018) Medicinal products database. Accessed 22 Apr 2018
  29. 29.
    Kassenärztliche Vereinigung Niedersachsen (2018) Orale Antikoagulation bei nicht-valvulärem Vorhofflimmern - NOAKS oder VKA? (2018) Accessed 23 Dec 2018
  30. 30.
    Farmacotherapeutisch Kompas (2018) Zorginstituut Nederland Accessed 23 Dec 2018Google Scholar
  31. 31.
    Law S, Ghag D, Grafstein E, Stenstrom R, Harris D (2016) A pharmacoeconomic study of traditional anticoagulation versus direct oral anticoagulation for the treatment of venous thromboembolism in the emergency department. CJEM 18(5):340–348CrossRefGoogle Scholar
  32. 32.
    Gómez-Outes A, Avendaño-Solá C, Terleira-Fernández AI, Vargas-Castrillón E (2014) Pharmacoeconomic evaluation of dabigatran, rivaroxaban and apixaban versus enoxaparin for the prevention of venous thromboembolism after total hip or knee replacement in Spain. Pharmacoeconomics 32(9):919–936CrossRefGoogle Scholar
  33. 33.
    López-López JA, Sterne JAC, Thom HHZ (2017) Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and cost effectiveness analysis. BMJ 359:j5058. CrossRefGoogle Scholar
  34. 34.
    O’shea SI, Ortel TL (2002) Issues in the utilization of low molecular weight heparins. Semin Hematol 39(3):172–178CrossRefGoogle Scholar
  35. 35.
    Donadini MP, Squizzato A, Ageno W (2017) Treating patients with cancer and acute venous thromboembolism. Expert Opin Pharmacother 17(4):535–543CrossRefGoogle Scholar
  36. 36.
    Bauersachs RM (2005) Fondaparinux: an update on new study results. Eur J Clin Investig 35(1):27–32CrossRefGoogle Scholar
  37. 37.
    Papastergiou J, Kheir N, Ladova K et al (2017) Pharmacists’ confidence when providing pharmaceutical care on anticoagulants, a multinational survey. Int J Clin Pharm 39(6):1282–1290CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec KraloveCharles UniversityHradec KraloveCzech Republic
  2. 2.Department of Clinical HematologyTeaching Hospital of Masaryk UniversityBrnoCzech Republic

Personalised recommendations