Treatment and Monitoring of Venous Thromboembolism (VTE) Among Hospitalized Patients in China

Abstract

Objectives: Despite increasing prevalence of venous thromboembolism (VTE) in China, real-world use of anticoagulants in clinical practice is not well understood. This study aims to assess treatment pattern and anticoagulant monitoring among hospitalized VTE patients in China. MethOds: Hospitalizations with a diagnosis of VTE (including deep vein thrombosis (DVT) or pulmonary embolism (PE)) between January 1 st , 2010 and June 30 th , 2013 were identified from a large electronic medical record database containing 100% inpatient records from two tertiary hospitals in two major cities. Analyses were performed to describe anticoagulant treatment among all VTE-related hospitalizations and international normalized ratio (INR) monitoring among hospitalizations where warfarin was used. Multivariate regressions were performed to assess factors associated with oral anticoagulant use, including type of VTE, patient demographics, comorbidities, insurance status, VTE diagnosis type, admission condition, ordering department, and surgical procedure. Results: Among a total of 1,047 VTE-related hospitalizations, mean age at hospitalization was 62.4 years, 54.1% of hospitalizations occurred to men, and 77.1% were DVT-related hospitalizations. About 46.3% hospitalizations used heparin only, 35.0% used warfarin (with or without heparin), 0.8% used rivaroxaban, and 18.0% did not use any anticoagulant. Among hospitalizations where warfarin was used, 90.8% received at least one INR test before discharge; among hospitalizations with INR results available, 30.0% had the last INR during hospitalization within target therapeutic range (2 to 3). Diagnosis of PE (vs. DVT), female, cardiovascular as ordering department, having surgical procedures, comorbidity of chronic pulmonary disorder, and VTE as primary diagnosis were significantly associated with higher oral anticoagulant use (all P < 0.05). cOnclusiOns: In China, use of innovative oral anticoagulants is limited among hospitalized VTE patients. Under-monitoring and suboptimal care may be an issue for hospitalized patients treated with warfarin. These findings reveal gaps in clinical practice and unmet needs among hospitalized patients with VTE in China.