Changing Treatment Patterns in Patients With Venous Thromboembolism in Taiwan

Abstract

Background: In Asia, little information is available about contemporary real-world treatment patterns for venous thromboembolism (VTE). Methods and Results: Consecutive patients (n=11,414) from the Taiwan National Health Insurance Research Database with initial VTE and taking oral anticoagulants between May 1, 2014 and June 30, 2016 were included. The temporal trends of using oral anticoagulants and pharmacomechanical therapy during the study period were evaluated. The efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) vs. warfarin were compared. Propensity score analysis (NOACs n=3,647 vs. warfarin n=3,647) was used to balance covariates between groups, and Cox proportional hazards models with adjustment were used to estimate the risks of clinical outcomes. The use of NOACs increased from 0.3% to 60.2% for VTE treatment during the study period. Pharmacomechanical therapy was used in 9.60%, 8.22%, and 5.63% from 2014 through 2016. NOACs were associated with a 16% risk reduction (adjusted hazard ratio [aHR] 0.84, 95% confidence interval [CI] 0.77-0.93) in all-cause mortality and a 21% risk reduction (aHR 0.79, 95% CI 0.65-0.96) in recurrent VTE vs. warfarin. Overall, NOACs were associated with a lower risk of major bleeding compared with warfarin (aHR 0.804, 95% CI 0.648-0.998). Conclusions: In real-world practice, NOACs have become the major anticoagulant used for Asians with VTE. Although NOACs had a lower risk of recurrent VTE and major bleeding compared with warfarin in Taiwan, we still need a large-scale randomized controlled trial to confirm the findings.

Epidemiology and Treatment Patterns of Venous Thromboembolism: an Observational Study of Nationwide Time-Series Trends in Japan

“…To date, epidemiological studies on inpatients with VTE have been conducted in Denmark [ 15 ] and Japan [ 16 ], and the frequency of hospitalization for VTE in these countries has been determined. Regarding pharmaceutical treatment, previous studies have shown that DOAC use has increased in hospitalized patients with VTE while warfarin use has decreased [ 16 , 17 ]. However, these studies were mostly limited to inpatients, and the number of studies examining the epidemiology and treatment status in both inpatients and outpatients with VTE is limited.…”

Dynamic Patterns and Persistence of Anticoagulation Therapy in Patients with Venous Thromboembolism in South Korea: A Nationwide Cohort Study

“…The temporal trends of initial anticoagulant therapy in the group without active cancer indicated decreases for warfarin but increases for NOACs, a trend that was consistent with that reported in several previous studies. 21 22 23 24 In particular, rivaroxaban was the most prescribed NOAC across all studies, likely because of the rapid market access and preference toward a once-daily dosing regimen. 25 Sizeable proportions of noncancer patients who initiated PAC were observed in our study.…”

A Comparison among Nonvitamin K Antagonist Oral Anticoagulants in Asian Patients with Venous Thromboembolism: A Multi-Institutional Study

“…Therefore, future studies with a longer follow-up are required to confirm the present findings. Third, although we included four DOACs, most patients (68.4%) received rivaroxaban, the first DOAC to be reimbursed by the Taiwan National Health Insurance in 2014 for VTE treatment [ 23 ]. The lesser use of other DOACs may have contributed to a potential bias in the event analysis.…”