Many clinicians participating in the Medicare Part D program continue to prescribe warfarin over direct-acting oral anticoagulants (DOACs), despite long-standing research showing that the latter drugs are safer and more effective for older patients, a new study finds.
The cohort study used Medicare prescription claims data involving more than 325,000 clinicians from 2013 to 2018. Investigators found a rapid uptake of DOACs among clinician prescribers who provided care to Medicare beneficiaries, representing 57% of oral anticoagulation prescriptions in 2018.
But many general medical specialists continued to use warfarin as their main or only anticoagulant instead of DOACs during the study period. This included 20% of general medicine practitioners who exclusively used warfarin in 2018.
Notably, those who prescribed only warfarin in 2013 were less likely to use DOACs throughout the study period than those who prescribed only DOACs in 2013. In addition, increased use of DOACs often appeared to reflect prescriptions for new patients only. This pattern suggests “prescriber and patient inertia,” according to study lead Rohan Khera, M.D., of Yale New Haven Hospital, and colleagues.
DOACs may be particularly helpful for older patients who are at high risk of bleeding and are more likely to have difficulties participating in frequent laboratory monitoring, the researchers noted.
“There is a need to address barriers to the uptake of these medications to realize their potential benefits for patients,” they wrote.
In 2019, the American College of Cardiology recommended that clinicians use DOACs over warfarin for patients with nonvalvular atrial fibrillation, followed by a similar recommendation by the American Society of Hematology in 2020.
The study was published in JAMA Network Open.