Journal of Thrombosis and Thrombolysis

, Volume 44, Issue 4, pp 435–441 | Cite as

High number of newly initiated direct oral anticoagulant users switch to alternate anticoagulant therapy

  • Beenish S. Manzoor
  • Surrey M. Walton
  • Lisa K. Sharp
  • William L. Galanter
  • Todd A. Lee
  • Edith A. Nutescu


Real-world evidence focusing on medication switching patterns amongst direct oral anticoagulant (DOACs) has not been well studied. The objective of this study is to evaluate patterns of prescription switching in non-valvular atrial fibrillation (NVAF) patients initiated on a DOAC and previously naïve to anticoagulation (AC) therapy. Data was obtained from Truven Health MarketScan® Commercial and Medicare Supplemental database (2009–2013). AC naïve (those without prior anticoagulant use) NVAF patients initiated on a DOAC, with 6 months of continuous health plan enrollment before and after treatment initiation and maintained on continuous therapy for a minimum of 6 months were included. Of 34,022 AC naïve NVAF patients initiating a DOAC, 6613 (19.4%) patients switched from an index DOAC prescription to an alternate anticoagulant and 27,409 (80.6%) remained on the DOAC [age: 68.5 ± 11.7 vs. 67.1 ± 12.7 years, p < 0.001; males: 3781 (57.2%) vs. 17,160 (62.6%), p < 0.001]. Amongst those that switched medication, 3196 (48.3%) did so within the first 6 months of therapy. Overall, 2945 (44.5%) patients switched to warfarin, 2912 (44.0%) switched to another DOAC and 756 (11.4%) switched to an injectable anticoagulant. The highest proportion of patients switched from dabigatran to warfarin (N = 2320; 42.5%) or rivaroxaban (N = 2252; 41.3%). The median time to switch from the index DOAC to another DOAC was 309.5 days versus 118.0 days (p < 0.001) to switch to warfarin. In NVAF patients newly initiated on DOAC therapy, one in five patients switch to an alternate anticoagulant and one of every two patients do so within the first 6 months of therapy. Switching from an initial DOAC prescription to traditional anticoagulants occurs as frequently as switching to an alternate DOAC.


Direct oral anticoagulants Atrial fibrillation Switching patterns Switching therapy Rivaroxaban Dabigatran Apixaban 



Department of Pharmacy Systems, Outcomes and Policy (PSOP) and the Center for Pharmacoepidemiology and Pharmacoeconomic Research (CPR) at University of Illinois at Chicago for providing material support to the research. Dr. Galanter is supported by grant U19HS021093 from the Agency for Healthcare Research and Quality. Dr. Nutescu is supported by the National Heart, Lung, And Blood Institute Award Number K23HL112908 and the National Institute on Minority Health and Health Disparities Award Number U54MD010723. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Beenish S. Manzoor
    • 1
  • Surrey M. Walton
    • 1
    • 2
  • Lisa K. Sharp
    • 1
    • 2
  • William L. Galanter
    • 1
    • 3
  • Todd A. Lee
    • 1
    • 2
  • Edith A. Nutescu
    • 1
    • 2
  1. 1.Department of Pharmacy, Systems Outcomes and Policy, College of PharmacyUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of PharmacyUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Department of Academic Internal Medicine & Geriatrics, College of MedicineUniversity of Illinois at ChicagoChicagoUSA

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