Impact of COVID-19 pandemic on the prescribing pattern of oral anticoagulants in the English primary care setting: a population-based segmented interrupted time series analysis of over 53 million individuals.

Background: The COVID-19 pandemic disrupted healthcare delivery, impacting oral anticoagulants (OAC) prescribing due to increased thromboembolic risks, Vaccine-induced immune thrombotic thrombocytopenia, and guidelines favoring Direct Oral Anticoagulants (DOACs) over warfarin. Previous studies were limited to short-term analyses.

Research Design And Methods: A segmented interrupted time series analysis was conducted using the English primary care Prescription Cost Analysis data from March/2018-March/2024 to assess the impact of the first and second COVID-19 lockdowns in March and November 2020, respectively. Trends in OAC utilisation were measured using number of items per 1,000 inhabitants (NIT) and defined daily dose per 1,000 inhabitants per day (DTD).

Results: Overall, oral anticoagulants prescribing increased significantly. Pre-pandemic, both NIT (β: 0.09; 95%CI: 0.02, 0.16) and DTD (β:0.13; 95%CI: 0.09, 0.16) showed positive trends. Post-first lockdown, DTD slope declined significantly (β:-0.22; 95%CI: -0.42, -0.03). Post-second lockdown, DTD rose in both immediate level (β:1.39; 95%CI: 0.34, 2.45) and slope (β: 0.20; 95%CI: 0.0015, 0.39). Warfarin usage declined initially but rebounded, while DOACs, particularly apixaban, increased substantially (β:0.96; 95%CI: 0.11, 1.81).

Conclusions: The COVID-19 pandemic significantly impacted oral anticoagulant prescribing patterns in England. While DOAC utilisation continued to rise, warfarin use declined significantly post-first lockdown but rebounded after the second lockdown.