Inpatient and outpatient treatment patterns of cancer-associated thrombosis in the United States

Abstract

Low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are among the recommended treatment options for cancer-associated thrombosis (CAT) in the 2019 National Comprehensive Care Network guidelines. Little is known about the current utilization of DOACs in CAT patients, particularly on the inpatient to outpatient therapy transition. This study assessed real-world treatment patterns of CAT in hospital/ED in adult cancer patients (≥ 18 years) diagnosed with CAT during a hospital visit in IQVIA's Hospital Charge Data Master database between July 1, 2015 and April 30, 2018, and followed their outpatient medical and pharmacy claims to evaluate the initial inpatient/ED and outpatient anticoagulants received within 3 months post-discharge. Results showed that LMWH and unfractionated heparin (UFH) were the most common initial inpatient/ED CAT treatments (35.2% and 27.4%, respectively), followed by DOACs (9.6%); 20.8% of patients received no anticoagulants. Most DOAC patients remained on DOACs from inpatient/ED to outpatient settings (71.4%), while 24.1%, 43.5%, and 0.1% of patients treated with LMWH, warfarin, or UFH respectively, remained on the same therapy after discharge. In addition, DOACs were the most common initial post-discharge outpatient therapy. Outpatient treatment persistence and adherence appeared higher in patients using DOACs or warfarin versus LMWH or UFH. This study shows that DOACs are used as an inpatient/ED treatment option for CAT, and are associated with less post-discharge treatment switching and higher persistence and adherence. Further research generating real-world evidence on the role of DOACs to help inform the complex CAT clinical treatment decisions is warranted.

Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

“…8 24 Although previous studies have shown that daily LMWH self-injections are well accepted by patients with CAT, our findings indicated the treating physicians experience a growing expectation from patients to choose a DOAC, supporting previous observations that patients with cancer generally prefer orally administered drugs if they are equally effective. 25 26 27 28 29 In a complex clinical situation as CAT, patients' needs and preferences are diverse, and incorporating the patients' attitude regarding the anticoagulant treatment is essential. 30 Concordant, many of the free-text responses indicated that treating physicians in this survey included patient preferences when weighing treatment decisions.…”

Current status of treatment of cancer-associated venous thromboembolism

“…DOACs were the most common initial post-discharge outpatient option. Persistence and adherence in outpatients appeared higher in patients using DOACs or warfarin versus LMWH or UFH [ 8 ]. In another retrospective cohort study, from 2000 through 2003, warfarin ± injectable was used in approximately 90% of cases.…”

Role of direct oral anticoagulants in gastrointestinal cancer associated thrombosis “practical issues in clinical practice”—narrative review

“…The real world data from one the registries shows that LMWHs were the most common initial anticoagulation for CAT (25). In this review, the authors reviewed four sizeable real-world data sets for type of anticoagulation therapy for the initial and ongoing management of CAT (25)(26)(27)(28)(29). The two most extensive series included in this review included 8,125 and 14,086 patients, respectively.…”