Oral anticoagulants around the world: an updated state-of-the art analysis

Background: Prevention and management of thrombotic disorders is achieved through the use of anticoagulant drugs, including heparins, vitamin K antagonists (VKAs; namely warfarin) and the more recently developed antithrombotic agents [i.e., direct oral anticoagulants (DOACs], which include dabigatran, rivaroxaban, apixaban and edoxaban. Using Google Trends, this study aims to provide an up-to-date analysis of worldwide popularity of current commercially available oral anticoagulant agents. Methods: An electronic search was carried in Google Trends, simultaneously using the search terms “warfarin” AND “dabigatran” AND “rivaroxaban” AND “apixaban” AND “edoxaban”. No language or geographical restrictions were applied, but the electronic search was limited to the past 30 days from the current search date (i.e., between October 5, 2018 and November 5, 2018). Results: Overall, warfarin (55.0%) yielded the largest number of Google searches among the five oral anticoagulants throughout the study period, followed by apixaban (22.5%), rivaroxaban (18.3%), edoxaban (4.1%) and dabigatran (0.1%). Thus, warfarin remains the predominantly searched anticoagulant agent around the world. Compared to other oral anticoagulant drugs, rivaroxaban was more popular in China and in some South-American countries, apixaban was especially popular in some North-European and Latin American countries, whilst edoxaban and dabigatran were not often searched for in any country worldwide. Conclusions: According to our analysis, warfarin remains currently the most popular oral anticoagulant agent around the globe, rivaroxaban and apixaban are the second and third most popular, whilst the popularity of dabigatran, the original DOAC to be released, appears now very limited, and edoxaban, being the latest DOAC to be released, is starting to emerge in relevance.