Arrhythmia

A look at DOACs through Google goggles


Interest in direct oral anticoagulants is on the rise and warfarin is on the wane, according to a ‘big data’ analysis of the billions of daily Google searches worldwide.

The study used Google Trends to analyse web searches for either traditional anticoagulants or direct oral anticoagulants (DOACs) between January 2004 and May 2017

While searches for warfarin remained substantially higher than each of the other anticoagulants, the trend was a steady decline for the vitamin K antagonist.

Interest in heparin was largely unchanged while rivaroxaban and apixaban were rising steeply. Interest in dabigatran grew rapidly in 2010 but fell away from a peak in late 2011. Interest in endoxaban and fondaparinux remains low and steady.

Co-author Dr Emmanuel Favaloro, principal hospital scientist at NSW Health Pathology’s Westmead laboratory, told the limbic the findings were consistent with local prescription data and clinical experience.

“Google Trends is a one-stop shop in being able to see what’s going on globally.”

“It’s good to see the data using one metric, in this case Google Trends, fits with what other data is saying. Warfarin is reducing and I suspect by 2018 there may be a change – warfarin may have slipped below those DOACs.”

The search data reflects interest in drugs rather than useage with a significant peak of interest in heparin in 2008 coinciding with FDA recalls and reported adverse effects in contaminated supplies.

However Google Trends was a useful tool given the difficulty of accessing prescription data worldwide, Dr Favaloro said.

“Certainly the trends were as we’d expect. Dabigatran was the first DOAC but but got some very bad press, especially in New Zealand, when it was released onto the market.

There were quite a lot of reports of adverse events and I think it scared clinicians off initially.”

“Ultimately will be interesting to see where the competition between rivaroxaban and apixaban sits.”

Dr Favaloro said increasing use of DOACs had triggered concerns that clinicians were using the drugs either without realising or ignoring their effects on routine coagulation tests.

He said abnormal test results were then being followed up needlessly and there was a risk of patients being misidentified as having conditions such as thrombophilia.

“The big mantra about DOACs was that they don’t need to be monitored and some clinicians are actually taking that to mean they don’t affect the tests.”

“DOACs actually have an effect on coagulation tests; some more than others.”

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