Increasing Use of Anticoagulants in Germany and Its Impact on Hospitalization for Intracranial Bleeding.

Abstract

Direct oral anticoagulants (DOAC) have been developed and introduced into clinical practice. The lower risk of intracranial bleeding (ICB), combining subarachnoid (SAH) and intracerebral (ICH) hemorrhage, covering associated with DOACs is a persuading argument for a shift from vitamin k antagonists (VKA) to DOACs in anticoagulation strategies in patients with atrial fibrillation.1,2 In light of the evidence, increasing drug treatment rates of VKA in Germany in the years before DOAC were introduced should have been associated with an increase of the hospitalization rate for ICBs. Furthermore, with the introduction of DOACs on the German market in 2008, the hospitalization rate for ICB should have decreased. We, therefore, analyzed nationwide time trends of prescribed anticoagulants in outpatients and assessed its association to ICB in Germany from 2005 to 2014. The data that support the findings of this study are available from the corresponding author on reasonable request. Hospitals in Germany annually transfer their individual hospitalization data, to the Institute for the Hospital Remuneration System (InEK) that after a plausibility control forwards anonymized data to the Federal Bureau of Statistics. Based on a specific data set that we received from the Federal Bureau of Statistics we calculated crude and age-standardized annual hospitalization rates for SAH and ICH per 100 000 persons. The statutory health insurances provide regular anonymized reports of the statutory health insurances-drug information system according to a German law regulation. These reports are based on billing data from all statutory health insurances companies in Germany. Detailed lists of defined daily doses (DDD) of all anticoagulants prescribed in these years 2005 to 2014 were provided by the Wissenschaftliche Institut der AOK (WIDO) which is a scientific institute of the statutory health insurances AOK in Germany. In addition, we calculated annual drug treatment rates per 100 000 persons by using the …