(P-014) Dispensing Patterns of Antithrombotic Agents in South Africa with Specific Focus on the Direct Oral Anticoagulants (DOACs): A Database Analysis

Background: Direct oral anticoagulants (DOACs) are changing the practice of anticoagulation and are associated with increased cost.

Objectives: To determine the dispensing trends of antithrombotic agents in South Africa with specific focus on the DOACs.

Methods: A retrospective, cross-sectional drug utilisation study was conducted on a 2019 medical insurance scheme database in South Africa. All records for ATC subgroup B01A were analysed.

Results: A total of 46 537 products were dispensed in ATC subgroup B01A to 7 997 patients, at a total amount paid of R6 552 672. The median age of patients was 52.00 (SD=14.84) years, ranging from 0 to 98 years (55.71% males). Acetylsalicylic acid (B01AC06) accounted for most of the products (60.75%), followed by enoxaparin (19.29%). Most prescriptions for the DOACs were dispensed by pharmacies (61.65%), followed by hospitals (36.16%). Of the three DOACs that were prescribed, 1 237 products were for rivaroxaban (ATC code B01AF01), 259 for dabigatran (ATC code B01AE07) and 3 for apixaban (ATC code B01AF02). No generic equivalents for these products were available in South Africa. Of the 328 patients who received rivaroxaban, 53.96% were male. The median age of patients on rivaroxaban was 57.00 (SD=15.37) years. Rivaroxaban was available in 10 mg tablets (229 prescriptions), 15 mg tablets (263 prescriptions) and 20 mg tablets (745 prescriptions). Most prescriptions (60.63%) for rivaroxaban were dispensed by pharmacies and 34.60% by hospitals. A variety of providers prescribed rivaroxaban, including cardiologists, specialist physicians, haematologists, orthopaedic specialists and oncologists. Patients received an average of 3.77 prescriptions for rivaroxaban during the year. Dabigatran was prescribed to 47 patients (median age: 72.00 (SD=13.73) years, 59.57% males) and was available as 75 mg, 110 mg and 150 mg capsules. Most dabigatran prescriptions (89.19%) were dispensed by pharmacies, with few prescriptions given in hospital. Apixaban (5 mg and 25 mg tablets) was recently introduced onto the South African market. Only three prescriptions for apixaban were dispensed to two female patients, both patients were in hospital.

Conclusions: Similar to a previous study, rivaroxaban was the most prescribed DOAC. Studies on switch patterns and adherence amongst patients taking DOACs are recommended.