Oral Anticoagulation Therapy for Venous Thromboembolism in Norway: Time Trends and Treatment Patterns

Ghanima, Waleed; Schultze, Anna; Donaldson, Robert M.; Brodin, Ellen; Halvorsen, Sigrun; Graham, Sophie; Carroll, Robert; Ulvestad, Maria; Lambrelli, Dimitra

doi:10.1016/j.clinthera.2021.04.017

Cited by 4 publications

(5 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…This nding is in line with several drug utilization studies. 14,15,27 Prescriptions on warfarin decreased by over 25% within the four-year period. Dabigatran and rivaroxaban accounted for approximately 60% of the total ED oral anticoagulant prescriptions in 2019.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Several studies have been conducted to investigate the prescription of anticoagulants in VTE patients to obtain an extensive understanding of this gap between medical recommendations and clinical practice. 14,15 However, little is known concerning the trend in anticoagulant prescription for ED patients with VTE. 12 The current study retrieved all available prescriptions of anticoagulants from the EDs of four major cities in China as representatives.…”

Section: Introductionmentioning

confidence: 99%

Trends in Emergency Department Anticoagulant Prescription for Patients with Venous Thromboembolism in China, 2016-2019

Wang

Liu

Zhao

et al. 2022

Preprint

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Introduction: Untreated acute venous thromboembolism (VTE) can have catastrophic consequences. Patients should be anticoagulated as soon as VTE is diagnosed. Based on the current clinical guidelines, direct oral anticoagulants (DOACs) are recommended as the first-line anticoagulant treatment for VTE. However, the selection of anticoagulants is a complex task, especially in the emergency department (ED). Methods This population-based drug utilization study was conducted to investigate the status of anticoagulant prescriptions for VTE treated in the ED (ED-VTE; ICD-10 codes I26, I80, I82, and I27.82) and the trend in these prescriptions in four major Chinese cities (Beijing, Tianjin, Shanghai, and Guangzhou) between 2016.1.1 and 2019.12.31. All data were retrieved from a cooperative data program established by the Peking Union Medical College Hospital. Patients who were anticoagulated for initial or recurrent VTE in the EDs of participating institutions during the study period were included in the present analysis. The primary objective was to characterize the trend in anticoagulant prescriptions for ED-VTE; the secondary objective was to calculate the average cost of anticoagulants per prescription. The sample size was not estimated before data collection due to the retrospective nature of the study and the current scarcity of data on anticoagulant prescribing for ED-VTE. Results a total of 4609 prescriptions for anticoagulants were retrieved; none of these records was found to have incomplete data. The anticoagulants prescribed in the current study included low-molecular-weight heparin (LMWH), warfarin, dabigatran, and rivaroxaban. Of the included prescriptions, 63.9% were given to patients over 65 years old, and 55.0% were given to females. The city of Shanghai accounted for nearly half of the prescriptions. Generally, LMWH was the most frequently prescribed anticoagulant in the ED. Warfarin accounted for more than 60% of all oral anticoagulant prescriptions during the study period; the second most prescribed oral anticoagulant was rivaroxaban (32.1%). The utilization of rivaroxaban increased to 48.4% of all oral anticoagulants in 2019. Dabigatran was less frequently prescribed. Conclusion The selection of anticoagulants in the ED was complex. LMWH remained the most prescribed anticoagulant regardless of time, gender, institution location, or cost. Warfarin was the most prescribed oral anticoagulant from 2016 to 2018, but the number of rivaroxaban prescriptions exceeded the number of warfarin prescriptions in 2019. DOACs accounted for an increasing share of anticoagulant prescriptions during the study period. Further investigations are warranted.

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“…[10] Anticoagulant treatment for subsequent VTEs was assumed to be either DOACs or phased anticoagulation (LMWH followed by warfarin); a 40:60 split was assumed based on registry data, [22] with higher use of DOACs explored in a scenario analysis given contemporaneous international data suggesting wider use with increasing familiarity. [23] The effectiveness of prophylactic LMWH was taken from a systematic review and network metaanalysis conducted by Wade et al, which reported the odds ratio (OR) for LMWH versus no LMWH (OR=0.26, 95% Confidence Interval [CI] 0.09 to 0.87) for the outcome of hospital acquired VTE in surgical patients. [24] Subsequent research published after completion of our work confirms this estimate of effectiveness; Marcucci et al report the OR for LMWH to range between 0.19 and 0.33 (depending on dose) for the outcome of symptomatic VTE compared to no active treatment, within a cohort of 45,445 patients undergoing non-cardiac surgery.…”

Section: Risk Assessment Modelsmentioning

confidence: 99%

Decision-analysis modeling of effectiveness and cost-effectiveness of pharmacologic thromboprophylaxis for surgical inpatients using variable risk assessment models or other strategies

Davis¹,

Goodacre²,

Horner³

et al. 2023

Journal of Thrombosis and Haemostasis

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Oral Anticoagulation Therapy for Venous Thromboembolism in Norway: Time Trends and Treatment Patterns

Cited by 4 publications

References 44 publications

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

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

Trends in Emergency Department Anticoagulant Prescription for Patients with Venous Thromboembolism in China, 2016-2019

Decision-analysis modeling of effectiveness and cost-effectiveness of pharmacologic thromboprophylaxis for surgical inpatients using variable risk assessment models or other strategies

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