Specific analysis of the trends shows that the score of warfarin exhibits a highly significant decrease over time (r=−0.40 P<0.001), whilst that of heparin has remained virtually unchanged (r=0.12 P=0.127), and that of fondaparinux has marginally increased (r=0.16 P=0.038). Results: The median Google Trends score of warfarin (i.e., 86) was consistently higher than that of heparin (54 P<0.001), fondaparinux (6 P<0.001), dabigatran (11 P<0.001), rivaroxaban (5 P<0.001), apixaban (1 P<0.001) and edoxaban (1 P<0.001). No language restriction was applied, and the searches were carried out from the first date available in Google Trends (January 1 st, 2004) to present time (June 1 st, 2017). Methods: Two electronic searches were performed using Google Trends, the former using the keywords “warfarin” AND “heparin” AND “fondaparinux”, and the latter using the keywords “warfarin” AND “dabigatran” AND “rivaroxaban” AND “apixaban” AND “edoxaban”, both using the search criterion “prescription drug”. Due to increasing use of these drugs in routine practice, we planned an original study to investigate their worldwide diffusion using a popular Web-search engine.
Background: Four direct oral anticoagulants (DOACs) have been approved for clinical use by many medicines regulatory agencies around the world.
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