The use of novel oral anticoagulants (NOACs) will see a substantial rise in the anticoagulation market space after an initially sluggish uptake, and will start to be elected over warfarin, the current standard-of-care product in certain indications, according to an analyst with research and consulting firm GlobalData.

Dr Lakshmi Dharmarajan, GlobalData's Senior Analyst covering Cardiovascular and Metabolic Disorders, states that: "NOACs are increasingly being used in patients with venous thromboembolism (VTE) due to the drugs' rapid onset of action and the ability to be administered in fixed doses without the need for regular coagulation monitoring.

"Among the VTE population, the fastest to adopt NOACs have been the orthopedic patient segments, for the prevention of deep vein thrombosis (DVT)."

For those with DVT, Xarelto has been demonstrated by real-world studies to have economic advantages over standard-of-care treatments.

As Dr Dharmarajan explains: "Positive evidence such as shorter hospital stays, in addition to the obvious clinical benefits of these drugs, will encourage payers and healthcare systems to recognize their financial advantages over existing treatments.

"For the anticoagulation market in general, a concerted effort by NOAC manufacturers to provide clinical practice evidence is absolutely essential for these drugs to challenge the 65-year legacy built by warfarin."

Fortunately for such manufacturers, the launch of reversal agents will help boost NOAC usage in the near future.

Even in cost-conscious markets such as the UK, physicians envision a dramatic shift towards NOACs, at least for the majority of the VTE population.

"For NOAC developers, the next step should be to evaluate the efficacy and safety of the drugs for patients with VTE and cancer, and also for the prophylaxis of VTE. This would enable the treatment to achieve universal acceptance in the VTE population as the standard-of-care therapy," the analyst concludes.