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The Anticoagulants Market report segments the industry into By Drug Class (Novel Oral Anticoagulants (NOACs), Heparin and Low Molecular Weight Heparin (LMWH), Vitamin K Antagonist), By Application (Atrial Fibrillation/Myocardial Infarction, Deep Vein Thrombosis (DVT), Pulmonary Embolism, Other Applications), and Geography (North America, Europe, Asia-Pacific, Middle East and Africa, South America).
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Anticoagulants Market Size 2024-2028
The anticoagulants market size is forecast to increase by USD 20.14 billion at a CAGR of 8.68% between 2023 and 2028.
The market is experiencing significant growth due to several key trends. The introduction of novel oral anticoagulants (NOACs) is one such trend, offering advantages over traditional anticoagulants in terms of efficacy, safety, and convenience. Another trend is the advent of anticoagulant antidotes, which have become essential in managing bleeding complications associated with knee replacement and anticoagulant therapy. The route of administration and coagulation pathway targeted vary, with genetic testing playing a crucial role in determining the most effective treatment for individual patients. However, the market also faces challenges, including the strong side-effects of anticoagulants, such as bleeding risks, and the need for regular monitoring and dose adjustments. These factors necessitate careful consideration of patient risk factors and close monitoring to ensure optimal outcomes. Overall, the market is poised for growth, driven by these trends and the ongoing development of innovative treatments and solutions.
What will be the Size of the Anticoagulants Market During the Forecast Period?
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The market encompasses a range of drugs used to prevent and manage various chronic disorders associated with blood clot formation, including deep vein thrombosis, cardiovascular diseases, and conditions like atrial fibrillation, myocardial infarction, and pulmonary embolism. Novel oral anticoagulants and injectable anticoagulants, collectively referred to as anticoagulant drugs or blood thinners, are the primary drug categories in this market. The prevalence of chronic disorders, particularly In the geriatric population and those with obesity, drives market growth.
Moreover, key conditions treated include artery and vein disorders, such as venous thromboembolism, synthetic biology and coagulation-related cardiovascular disorders. Product penetration In the market is influenced by factors like patient compliance, safety, and efficacy. Anticoagulants are essential in preventing blood clotting time extension, thereby reducing the risk of complications from blood clots.
How is this Anticoagulants Industry segmented and which is the largest segment?
The anticoagulants industry research report provides comprehensive data (region-wise segment analysis), with forecasts and estimates in 'USD billion' for the period 2024-2028, as well as historical data from 2018-2022 for the following segments.
Route Of Administration
Oral anticoagulants
Injectable anticoagulants
Type
Factor Xa inhibitors
DTIs
Heparin
Vitamin K antagonists
Geography
North America
Canada
US
Europe
Germany
UK
Asia
Japan
Rest of World (ROW)
By Route Of Administration Insights
The oral anticoagulants segment is estimated to witness significant growth during the forecast period.
Traditional oral anticoagulants such as warfarin (COUMADIN) and generic warfarin have been on the market for the past 50 years. These drugs belong to vitamin K antagonists and prevent the activation of vitamin K. Warfarin is used for various indications, including DVT/PE, AF, paroxysmal nocturnal hemoglobinuria (PNH), mitral stenosis or regurgitation, dilated cardiomyopathy, arterial grafts, and during placement of artificial valves.
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The oral anticoagulants segment was valued at USD 21.14 billion in 2018 and showed a gradual increase during the forecast period.
Regional Analysis
North America is estimated to contribute 51% to the growth of the global market during the forecast period.
Technavio's analysts have elaborately explained the regional trends and drivers that shape the market during the forecast period.
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The North American market is witnessing notable expansion due to the rising incidence of deep vein thrombosis (DVT) and venous thromboembolism (VTE) In the region. The US, in particular, has a high prevalence of these chronic disorders, contributing approximately 22.98% to the global market revenue. According to the Centers for Disease Control and Prevention (CDC), there are nearly 900,000 new cases of DVT and pulmonary embolism In the US annually. Factors such as heightened awareness of these conditions and an advanced healthcare system are fueling market growth. Anticoagulant drugs, including novel oral anticoagulants (NOACs), warfarin, and heparin, are used to prevent blood clot formation in cardiovascular diseases such as atrial fibrillation, myocardial infarction, and stroke. Genetic testing and pharmacogenomics play a crucial role in optimizing antico
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The Direct Oral Anticoagulants Market is estimated to be valued at USD 32.4 billion in 2025 and is projected to reach USD 66.8 billion by 2035, registering a compound annual growth rate (CAGR) of 7.5% over the forecast period.
| Metric | Value |
|---|---|
| Industry Size (2025E) | USD 32.4 billion |
| Industry Value (2035F) | USD 66.8 billion |
| CAGR (2025 to 2035) | 7.5% |
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Anticoagulants Market size was valued at USD 30.84 Billion in 2024 and is projected to reach USD 54.59 Billion by 2032, growing at a CAGR of 8.5% during the forecast period 2026-2032.• Rising Prevalence of Cardiovascular Diseases: The increasing incidence of cardiovascular diseases (CVDs) such as atrial fibrillation (AF), deep vein thrombosis (DVT), and pulmonary embolism (PE) is a primary catalyst for the anticoagulants market. Atrial fibrillation, a common type of heart arrhythmia, significantly raises the risk of stroke due to the formation of blood clots in the heart.• Aging Global Population: A growing global elderly population is a significant demographic driver for the anticoagulants market. As people age, their risk of developing blood clotting disorders, including atrial fibrillation and venous thromboembolism, increases exponentially.
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Check Market Research Intellect's Anticoagulant Market Report, pegged at USD 12.5 billion in 2024 and projected to reach USD 20.8 billion by 2033, advancing with a CAGR of 7.5% (2026-2033).Explore factors such as rising applications, technological shifts, and industry leaders.
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According to our latest research, the global anticoagulants market size reached USD 39.2 billion in 2024, reflecting robust demand driven by the increasing prevalence of cardiovascular diseases and venous thromboembolism. The market is expected to grow at a compound annual growth rate (CAGR) of 7.1% from 2025 to 2033, and is forecasted to reach USD 72.9 billion by 2033. This upward trajectory is primarily fueled by the aging global population, lifestyle changes leading to higher incidences of thrombosis, and ongoing advancements in drug development and delivery methods.
A key growth factor for the anticoagulants market is the rising global burden of chronic cardiovascular conditions, including atrial fibrillation, deep vein thrombosis, and pulmonary embolism. These disorders are among the leading causes of morbidity and mortality worldwide, necessitating effective prevention and management strategies. Anticoagulants, commonly known as blood thinners, play a pivotal role in reducing the risk of life-threatening blood clots, strokes, and related complications. As awareness about early diagnosis and treatment continues to improve, especially in emerging economies, the adoption of anticoagulant therapies is expected to surge, further propelling market growth.
Another significant driver is the technological innovation in drug formulations and delivery systems. The introduction of direct oral anticoagulants (DOACs) has transformed the therapeutic landscape by offering improved efficacy, safety profiles, and ease of administration compared to traditional agents like warfarin and heparin. Pharmaceutical companies are investing heavily in research and development to create next-generation anticoagulants with reduced side effects, fewer drug interactions, and enhanced patient compliance. This ongoing innovation is expanding the scope of anticoagulant use across various clinical settings and patient demographics.
The anticoagulants market is also benefiting from supportive regulatory policies, increasing healthcare expenditures, and the expansion of healthcare infrastructure, particularly in developing regions. Governments and non-governmental organizations are launching initiatives to improve cardiovascular health, which include screening programs, public education campaigns, and subsidized access to essential medications. Additionally, the growing trend toward homecare and personalized medicine is creating new avenues for market expansion, as patients and healthcare providers seek convenient and tailored therapeutic solutions.
From a regional perspective, North America continues to dominate the global anticoagulants market, accounting for the largest revenue share in 2024, followed by Europe and Asia Pacific. The high prevalence of lifestyle-related health conditions, widespread adoption of advanced therapies, and well-established healthcare systems contribute to the region's leading position. However, Asia Pacific is expected to witness the fastest growth during the forecast period, driven by rising healthcare awareness, increasing investment in healthcare infrastructure, and the growing burden of cardiovascular diseases in countries such as China and India. Latin America and the Middle East & Africa, while currently representing smaller shares, are anticipated to show steady growth as access to healthcare improves and awareness initiatives gain traction.
The anticoagulants market is segmented by drug type into Direct Oral Anticoagulants (DOACs), Heparin & Low Molecular Weight Heparin, Vitamin K Antagonists, and Others. Among these, DOACs have emerged as the fastest-growing and most preferred category, largely due to their favorable efficacy and safety profiles. DOACs, such as rivaroxaban, apixaban, and dabigatran, offer several advantages over traditional anticoagulants, including fixed dosing, fewer dietary restrictions, and minimal need for routine monitoring. This has led to widespread adoption among both healthcare professionals and patients, especially in developed markets. The convenience and reduced risk of bleeding complications associated with DOACs have positioned them as the treatment of choice for a wide range of indications, including atrial fibrillation and venous thromboembolism.
Heparin and low molecular weight heparin (LMWH) remain essential in hospital settings, particular
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In 2023, the global Novel Oral Anticoagulants (NOAC) market size was estimated at approximately USD 12 billion and is projected to reach USD 24 billion by 2032, demonstrating a robust Compound Annual Growth Rate (CAGR) of 8%. This substantial growth is fueled by the increasing prevalence of cardiovascular diseases and the rising need for more effective and safer anticoagulant medications. NOACs have emerged as a significant advancement in the field of anticoagulation therapy, offering advantages over traditional vitamin K antagonists such as easier administration, fewer dietary restrictions, and a predictable pharmacokinetic profile, which contributes significantly to their growing adoption worldwide.
One of the key growth factors driving the NOAC market is the increasing incidence of atrial fibrillation (AF) and other cardiovascular disorders. The global burden of AF is steadily rising, with millions of new cases diagnosed annually. As a leading cause of stroke and systemic embolism, AF necessitates long-term anticoagulation therapy, and NOACs have become the preferred choice due to their efficacy and safety profile. Furthermore, the aging global population is contributing to the increased prevalence of cardiovascular conditions, thereby expanding the patient pool that requires anticoagulation management, thus propelling the demand for NOACs.
The pharmaceutical industryÂ’s ongoing investment in research and development is another critical factor bolstering the growth of the NOAC market. Many companies are focusing on enhancing the efficacy and safety profiles of existing NOACs as well as developing new drugs to address unmet clinical needs. The development of generic versions of NOACs is also anticipated to boost market growth by making these medications more accessible and affordable to a broader patient population. Moreover, the increasing awareness among healthcare professionals and patients regarding the benefits of NOACs over traditional anticoagulants is expected to further drive market expansion in the coming years.
Advancements in healthcare infrastructure, especially in developing regions, are also contributing to the growth of the NOAC market. Improved access to healthcare services and the increasing availability of sophisticated medical facilities are facilitating the diagnosis and treatment of cardiovascular diseases, subsequently driving the demand for NOACs. Additionally, favorable regulatory policies and the expedited approval process for NOACs in several countries are expected to support the marketÂ’s growth trajectory. However, the high cost of these medications and the risk of bleeding complications associated with their use may pose challenges to market expansion.
Regionally, North America is expected to hold the largest share of the NOAC market, driven by the high prevalence of cardiovascular diseases and the regionÂ’s well-established healthcare infrastructure. Europe is also anticipated to exhibit significant growth, supported by the increasing adoption of NOACs and favorable reimbursement policies. Meanwhile, the Asia Pacific region is projected to witness the fastest growth during the forecast period, attributed to the rapidly growing geriatric population, increasing healthcare expenditure, and rising awareness about anticoagulation therapy. Emerging markets in Latin America and the Middle East & Africa are also expected to contribute to the overall market growth, although at a slower pace, due to improving healthcare access and economic conditions.
Apixaban, a prominent player in the NOAC market, has been recognized for its superior safety profile, particularly in reducing bleeding risks compared to other anticoagulants. This factor has significantly contributed to its rapid adoption among healthcare providers and patients alike. Apixaban's efficacy has been demonstrated in numerous clinical trials, showcasing its ability to lower the incidence of stroke and systemic embolism in patients with atrial fibrillation. Its twice-daily dosing regimen, while slightly less convenient than once-daily alternatives, is often outweighed by its clinical benefits, making it a preferred choice in many therapeutic settings. As the demand for safer anticoagulation options continues to grow, Apixaban is well-positioned to maintain its competitive edge in the market.
The drug type segment in the NOAC market comprises Dabigatran, Rivaroxaban, Apixaban, Edoxaban,
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The global anticoagulant market is booming, driven by rising cardiovascular disease prevalence and innovative drug development. Explore market size, CAGR, key players (Bayer, Boehringer Ingelheim, Pfizer), regional trends (North America, Europe, Asia-Pacific), and segment analysis (oral, injectable) in this comprehensive market analysis. Discover future growth projections to 2033.
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Global Oral Anticoagulant Market is segmented by Application (Atrial fibrillation, Deep vein thrombosis, Pulmonary embolism, Stroke prevention, Cardiovascular diseases, Post-surgical care, Chronic conditions), Type (Direct oral anticoagulants, Vitamin K antagonists, Injectable anticoagulants, Novel agents, Combination therapies, Monitoring devices, Generic formulations), and Geography (North America_ LATAM_ West Europe_Central & Eastern Europe_ Northern Europe_ Southern Europe_ East Asia_ Southeast Asia_ South Asia_ Central Asia_ Oceania_ MEA)
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The global anticoagulant market is booming, driven by rising cardiovascular disease prevalence and advancements in NOACs. Explore market size, growth trends, leading companies, and regional analysis in our comprehensive report. Discover the impact of aging populations and innovative therapies on this rapidly expanding sector.
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The Global Anticoagulant Market is projected to reach USD 66.1 billion by 2033, up from USD 34.9 billion in 2023, at a CAGR of 6.6% during 2024–2033. Growth is driven by expanding clinical applications, regulatory support, and broader preventive use across healthcare systems. Rising awareness of venous thromboembolism (VTE) and other clotting disorders is leading to higher adoption of anticoagulants in both inpatient and outpatient care.
Hospitals are emphasizing routine VTE risk assessment as part of national quality standards. In England, 89% of adult admissions were assessed in 2024, encouraging consistent prophylactic anticoagulant use. These programs ensure early intervention and raise baseline utilization across healthcare providers. As prevention becomes a core component of hospital quality metrics, steady demand for both injectable and oral anticoagulants is being maintained worldwide.
The product landscape is shifting toward direct oral anticoagulants (DOACs), such as apixaban and dabigatran. These agents offer better safety, convenience, and adherence compared to vitamin K antagonists. In England, DOACs accounted for 85% of oral anticoagulant prescriptions in 2022, reflecting a clear preference in clinical practice. Global regulatory inclusion, such as India’s National List of Essential Medicines, further broadens access and affordability for these treatments.
Market growth is reinforced by the approval of new therapeutic indications and safety features. For instance, rivaroxaban’s expanded use with aspirin for chronic coronary and peripheral artery disease adds new patient segments. The availability of reversal agents like andexanet alfa and idarucizumab enhances physician confidence and promotes wider adoption in higher-risk patients. These advances are improving long-term therapy outcomes and supporting sustained prescription volumes.
Rising lifestyle-related diseases and chronic conditions are also boosting demand. Obesity, physical inactivity, and chronic kidney disease (CKD) significantly increase clot risks. WHO reports show 16% global obesity prevalence and around 674 million CKD patients in 2025. Additionally, trauma and orthopedic surgeries continue to drive short-term anticoagulant use. Together, these factors, coupled with home-monitoring coverage for warfarin users, ensure consistent market growth and strengthen the foundation for future expansion.
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The global anticoagulants market size attained a value of USD 37.65 Billion in 2024 driven by growing lifestyle risks like diabetes and obesity, along with the growing health awareness among the public, currently require better and efficient treatments. The market is anticipated to grow at a CAGR of 8.20% during the forecast period of 2025-2034 to attain a value of USD 82.80 Billion by 2034.
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According to Cognitive Market Research, the global Anticoagulants market size will be USD 44600 million in 2025. It will expand at a compound annual growth rate (CAGR) of 7.80% from 2025 to 2033.
North America held the major market share for more than 40% of the global revenue with a market size of USD 16502.00 million in 2025 and will grow at a compound annual growth rate (CAGR) of 6.3% from 2025 to 2033.
Europe accounted for a market share of over 30% of the global revenue with a market size of USD 12934.00 million.
APAC held a market share of around 23% of the global revenue with a market size of USD 10704.00 million in 2025 and will grow at a compound annual growth rate (CAGR) of 10.5% from 2025 to 2033.
South America has a market share of more than 5% of the global revenue with a market size of USD 1694.80 million in 2025 and will grow at a compound annual growth rate (CAGR) of 8.5% from 2025 to 2033.
The Middle East had a market share of around 2% of the global revenue and was estimated at a market size of USD 1784.00 million in 2025. and will grow at a compound annual growth rate (CAGR) of 9.1% from 2025 to 2033.
Africa had a market share of around 1% of the global revenue and was estimated at a market size of USD 981.20 million in 2025 and will grow at a compound annual growth rate (CAGR) of 8.1% from 2025 to 2033.
Oral category is the fastest growing segment of the Anticoagulants industry
Market Dynamics of Anticoagulants Market
Key Drivers for Anticoagulants Market
Increasing Incidence of Cardiovascular Diseases (CVDs) to Boost Market Growth
The rising prevalence of cardiovascular diseases (CVDs), including stroke, atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE), has a major impact on the market for anticoagulants. Anticoagulants are becoming more and more necessary as the prevalence of CVD increases as a result of ageing populations, obesity, and sedentary lifestyles. These medications are crucial for improving patient outcomes, reducing the risk of stroke, and avoiding potentially lethal blood clots. Developments in novel oral anticoagulants (NOACs), which offer safer and more useful alternatives to traditional treatments like warfarin, are also driving the market increase. As the global incidence of CVD cases continues to rise, pharmaceutical companies are expanding their anticoagulant portfolios to meet the increasing demand.
Growing Aging Population & Associated Risk of Blood Clots to Boost Market Growth
The market for anticoagulants is significantly influenced by the ageing population, as older people are more likely to experience blood clots because of their decreased mobility, chronic illnesses, and age-related cardiovascular disorders. The frequency of pulmonary embolism (PE), deep vein thrombosis (DVT), atrial fibrillation (AF), and stroke is increasing along with the world's life expectancy, which calls for long-term anticoagulant treatment. The market for novel oral anticoagulants (NOACs) is expanding because they provide safer and more practical substitutes for conventional medications like warfarin. Pharmaceutical companies are investing in cutting-edge anticoagulant formulations to address the unique medical requirements of the ageing population as healthcare systems place a greater emphasis on geriatric care.
Restraint Factor for the Anticoagulants Market
High Risk of Bleeding Complications, Will Limit Market Growth
A significant barrier to the market for anticoagulants is the high risk of bleeding problems, which restricts their broad use. Even while anticoagulants are necessary to avoid blood clots, they can cause serious bleeding episodes, such as cerebral bleeding, gastrointestinal bleeding, and excessive bruising. Physicians are careful when giving these medications because of this risk, particularly for elderly patients, those with a history of bleeding disorders, or those who need long-term therapy. The difficulty of treatment is increased by the requirement for routine monitoring, especially when using conventional anticoagulants like warfarin. Despite improvements in novel oral anticoagulants (NOACs) with reduced risks of bleeding, safety issues still impede market expansion, driving demand for reversal agents and safer substitutes.
Market Trends in Anticoagulants Market
Growing Adoption of Novel Oral Anticoagulants (NOACs)
The shift to novel oral anticoagulants (NOACs), which provi...
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| BASE YEAR | 2024 |
| HISTORICAL DATA | 2019 - 2023 |
| REGIONS COVERED | North America, Europe, APAC, South America, MEA |
| REPORT COVERAGE | Revenue Forecast, Competitive Landscape, Growth Factors, and Trends |
| MARKET SIZE 2024 | 40.8(USD Billion) |
| MARKET SIZE 2025 | 42.9(USD Billion) |
| MARKET SIZE 2035 | 70.0(USD Billion) |
| SEGMENTS COVERED | Mechanism of Action, Route of Administration, Therapeutic Area, Distribution Channel, Regional |
| COUNTRIES COVERED | US, Canada, Germany, UK, France, Russia, Italy, Spain, Rest of Europe, China, India, Japan, South Korea, Malaysia, Thailand, Indonesia, Rest of APAC, Brazil, Mexico, Argentina, Rest of South America, GCC, South Africa, Rest of MEA |
| KEY MARKET DYNAMICS | Rising prevalence of cardiovascular diseases, Increasing geriatric population, Growing awareness of anticoagulants, Advancements in drug formulations, Regulatory approvals and guidelines |
| MARKET FORECAST UNITS | USD Billion |
| KEY COMPANIES PROFILED | MSD, AstraZeneca, GSK, Boehringer Ingelheim, Johnson & Johnson, Bayer, Daiichi Sankyo, Amgen, Pfizer, Bristol Myers Squibb, Roche, AbbVie, Sanofi, Novartis, Luitpold Pharmaceuticals |
| MARKET FORECAST PERIOD | 2025 - 2035 |
| KEY MARKET OPPORTUNITIES | Growing geriatric population, Increasing cardiovascular diseases, Rising awareness of anticoagulants, Innovations in drug delivery systems, Expanding healthcare access in emerging markets |
| COMPOUND ANNUAL GROWTH RATE (CAGR) | 5.0% (2025 - 2035) |
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Global Oral Anticoagulant market size 2025 was XX Million. Oral Anticoagulant Industry compound annual growth rate (CAGR) will be XX% from 2025 till 2033.
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[236+ Pages Report] The global Oral Anticoagulants market size is expected to grow from USD 18 billion in 2021 to USD 34.1 billion by 2028, at a CAGR of 9.6% from 2022-2028
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[211+ Pages Report] The global Anticoagulants market size is expected to grow from USD 23,817.5 million in 2021 to USD 42,756.02 million by 2028, at a CAGR of 9.01% in forecast period (2022-2028)
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The global anticoagulant drugs market is poised for steady growth, projected to reach $30.18 billion in 2025 and maintain a Compound Annual Growth Rate (CAGR) of 4.6% from 2025 to 2033. This expansion is driven by several factors. The increasing prevalence of cardiovascular diseases, including atrial fibrillation and deep vein thrombosis, is a primary driver, creating a significant demand for effective anticoagulant therapies. Furthermore, advancements in anticoagulant drug development, such as the introduction of novel oral anticoagulants (NOACs) with improved safety profiles and reduced bleeding risks compared to warfarin, are fueling market growth. The growing geriatric population, which is more susceptible to thromboembolic events, also contributes significantly to market expansion. However, the market faces certain restraints, including the potential for adverse events associated with anticoagulant use and the high cost of newer therapies, particularly NOACs, which can limit accessibility in certain regions. Competition among major pharmaceutical players, including Bristol-Myers Squibb, Bayer, Pfizer, Johnson & Johnson, Sanofi, Boehringer Ingelheim, and Daiichi Sankyo, further shapes market dynamics. The market segmentation (data not provided) will likely reveal variations in growth rates across different anticoagulant drug types (e.g., NOACs, warfarin, heparin) and therapeutic applications (e.g., stroke prevention, deep vein thrombosis treatment). Regional differences in healthcare infrastructure, disease prevalence, and regulatory landscapes will influence market penetration rates. Future growth will depend on several factors, including the development of more targeted and personalized anticoagulant therapies, improved patient education and adherence to treatment regimens, and the ongoing evaluation of cost-effectiveness compared to existing treatment options. The industry is likely to witness further consolidation, strategic partnerships, and mergers and acquisitions as companies strive to strengthen their market position and develop innovative products. Overall, the anticoagulant drugs market is anticipated to witness continued expansion, driven by unmet clinical needs and the relentless pursuit of safer and more effective treatment strategies.
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Discover the booming anticoagulant market, projected to reach $70 billion by 2033. This in-depth analysis explores market size, CAGR, key drivers, trends, and competitive landscape, featuring leading players like Sanofi, Bayer, and Pfizer. Learn about the shift towards DOACs and future growth potential.
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The Peptide And Anticoagulant Drugs Market report segments the industry into By Route Of Administration (Peptide Drugs, Anticoagulant Drugs), By Application (Peptide Drugs, Anticoagulant Drugs), and By Geography (North America, Europe, Asia-Pacific, Middle East and Africa, South America). Get five years of historical data alongside five-year market forecasts.
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The Anticoagulants Market report segments the industry into By Drug Class (Novel Oral Anticoagulants (NOACs), Heparin and Low Molecular Weight Heparin (LMWH), Vitamin K Antagonist), By Application (Atrial Fibrillation/Myocardial Infarction, Deep Vein Thrombosis (DVT), Pulmonary Embolism, Other Applications), and Geography (North America, Europe, Asia-Pacific, Middle East and Africa, South America).