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

Abstract

Background Venous thromboembolism (VTE) is associated with increased morbidity, mortality, and healthcare expenditure. However, the comprehensive utilization of anticoagulation therapy in patients with VTE, especially regarding active cancer, in real-world practice remains unclear. Objective To describe the prescription, persistence, and patterns of anticoagulation therapy among patients with VTE stratified according to active cancer. Methods Using Korean nationwide claims data, we identified an incident, treatment-naïve cohort of patients with VTE from 2013 to 2019 and classified them according to the presence/absence of active cancer. We explored the secular trends, treatment patterns (e.g., discontinuation, interruption, and switch), and persistence of anticoagulation therapy. Results There were 48,504 and 7,255 patients without and with active cancer, respectively. NOACs were the most common anticoagulant in both groups (65.1% and 57.9%, respectively). The prescription of non-vitamin K antagonist oral anticoagulants (NOACs) increased steeply over time, regardless of active cancer, whereas parenteral anticoagulants (PACs) plateaued and warfarin decreased sharply. A heterogeneous pattern was observed between the groups without and with active cancer (3-month persistence was 60.8%, 62.9%, 57.2%, and 3.4%, respectively; 6-month persistence was 42.3%, 33.5%, 25.9%, and 1.2% vs. 9.9%). Median duration of continuous anticoagulant therapy for warfarin, NOAC, and PAC were 183, 147, and 3 days in non-active cancer patients, and 121, 117, and 44 days in active cancer patients. Conclusion Our findings suggest that there were substantial differences in persistence, patterns, and patient characteristics of anticoagulant therapy based on index anticoagulant and active cancer.

Thrombosis and Haemostasis 2023 Editors' Choice Papers

“…They investigated the uptake and persistence of anticoagulants in patients with and without cancer-related VTE in China between 2013 and 2019. 20 Their findings underscored a significant gap in treatment continuation, notably in cancer-associated VTE cases, despite guidelines recommending indefinite anticoagulation, which was likely attributable to lack of drug reimbursement and drug affordability issues in China. 21…”

Patterns and Persistence of Anticoagulant Use in the Treatment of Venous Thromboembolism: Insights from South Korea

“…5,6 In the current issue of the journal, Yoon et al examine trends in the use of DOACs, vitamin K antagonists, and parenteral anticoagulants in 48,504 and 7,255 patients with a new diagnosis of VTE without and with cancer, respectively, from 2013 to 2019, to provide important information on pattern of anticoagulant uptake and treatment persistence in the treatment of VTE in South Korea. 7 Using data from a large national administrative database (Korean Health Insurance Review and Assessment Service), their study reports three relevant findings. First, consistent with studies in other populations, DOACs have become the most prescribed anticoagulants for the treatment of VTE in South Korea.…”