Shifts Toward Direct Oral Anticoagulants in Ambulatory Care: Utilization Trends and SARIMA Forecasts

Background: Anticoagulant treatment is central to the prevention and management of thromboembolic cardiovascular disease, and contemporary practice has increasingly shifted toward direct oral anticoagulants. Objectives: To quantify ambulatory anticoagulant utilization trends in Greece during 2018 to 2022 and to forecast utilization through 2030 using standardized drug-utilization metrics. Methods: A retrospective pharmacoepidemiological analysis of community-pharmacy anticoagulant sales data in Greece was performed using IQVIA Greece data as a proxy for population-level drug consumption. Utilization was standardized as defined daily doses per 1000 inhabitants per day. Drug-specific temporal trends were evaluated, and seasonal autoregressive integrated moving average models were developed to generate forecasts through 2030. Results: Total sales-based anticoagulant consumption increased by 31.1%, from 24.84 defined daily doses per 1000 inhabitants per day in 2018 to 32.57 in 2022, corresponding to an average annual increase of 1.57. This increase was primarily driven by direct oral anticoagulants, particularly apixaban, which increased from 5.03 ± 0.36 to 9.91 ± 0.46, and rivaroxaban, which increased from 6.84 ± 0.32 to 9.38 ± 0.29. In contrast, acenocoumarol declined by 37.6%, from 4.02 ± 0.17 to 2.51 ± 0.08. Among parenteral anticoagulants, enoxaparin increased from 1.87 ± 0.11 to 2.65 ± 0.15, whereas nadroparin decreased from 0.06 ± 0.01 to 0.02 ± 0.01. By 2030, apixaban and rivaroxaban are forecast to reach 19.61 (95% CI 18.45 to 20.77) and 9.29 (95% CI 5.09 to 13.49), respectively, whereas acenocoumarol is projected to decline to 0.97 (95% CI 0.72 to 1.23). Conclusions: Sales-based anticoagulant consumption shifted toward direct oral anticoagulants, with concurrent declines in vitamin K antagonists and selected parenteral agents, trends that may inform cardiovascular care planning, reimbursement policy, and implementation of evidence-based anticoagulation strategies.