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

Abstract

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.