Internet Search Trends and Regional Mortality Tendencies: The Case of Oral Anticoagulants and Stroke
Roberto Muniz Ferreira et al. Ísis da Capela Pinheiro João Roquette Fleury da Rocha
Introduction
Multiple studies have found that up to 30% of ischemic strokes are associated with atrial fibrillation (AF), especially in the elderly population. , Although the embolic risk varies according to clinical characteristics and comorbidities, anticoagulant therapy has consistently shown to reduce stroke rates by approximately 70%. However, previous studies demonstrated that treatment rates with warfarin were low, even in patients at high risk for embolic events. Despite evidence from various publications demonstrating the effectiveness and safety of vitamin K antagonists, their complex pharmacokinetics and the need for continuous monitoring and frequent dose adjustments were the main explanations for low adherence.
Over the last 10 years, four direct oral anticoagulants (DOAC) have become available to prevent embolic events in patients with non-valvular AF: dabigatran, rivaroxaban, apixaban and edoxaban. In August 2011, dabigatran was the first DOAC approved in Brazil for stroke prevention, followed by rivaroxaban four months later. Two years later, apixaban was also introduced in the Brazilian market and only in February 2018 edoxaban became available. When compared to warfarin, multiple trials have suggested that DOACs are non-inferior in preventing ischemic strokes and possibly superior in reducing mortality, perhaps due to fewer intracranial hemorrhages. In addition to waive the need for laboratory monitoring, they have more predictable pharmacokinetics and a lower incidence of drug-to-drug interactions. Recent studies have demonstrated an increase in anticoagulation prescription rates among physicians since DOACs have become clinically available.
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