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Pharmacoepidemiol Drug Saf. 2018 Feb;27(2):174-181. doi: 10.1002/pds.4350. Epub 2017 Nov 15.

Use of direct oral anticoagulants in the first year after market entry of edoxaban: A Danish nationwide drug utilization study.

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Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.



To describe the early uptake of edoxaban; the fourth direct oral anticoagulant (DOAC) to enter the market.


Using the Danish nationwide health registries, we identified new users of edoxaban (n = 609) from June 6 (day of marketing) through June 2017. For comparison, we also identified new users of dabigatran (n = 2211), rivaroxaban (n = 19 227), and apixaban (n = 14 736). Users were described regarding indication of use, previous anticoagulant experience, comorbidity, and co-medication.


The rate of edoxaban initiation increased to 2.0 per 100 000 person months in June 2017, compared with 6.3, 37.5, and 27.0 for dabigatran, rivaroxaban, and apixaban. Atrial fibrillation was the most common registered indication for edoxaban (67%) as well as the other DOACs (41-55%). Overall, users of edoxaban were comparable to users of other DOACs (median age 75 vs 72-76 years and 57% vs 53-59% males), except for a generally lower concomitant use of other drugs. Noticeably, 95% of edoxaban users had previously received anticoagulant treatment compared with 31% to 43% for new users of other DOACs, with 77% switching directly from another anticoagulant treatment to edoxaban (45% directly from VKA and 32% directly from DOACs).


While the use of edoxaban is still limited compared with other DOACs, it is increasing. The majority of edoxaban users switch to edoxaban from other anticoagulant treatments. Continued monitoring of the utilization of DOACs, including effectiveness and safety, is considered essential to the safe and rational use of these drugs.


Denmark; anticoagulants; direct oral anticoagulants; drug utilization; edoxaban; pharmacoepidemiology


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