Highlights
- •Over half of patients did not initiate anticoagulant treatment within 30 days as recorded.
- •Rates of anticoagulant treatment initiation remained stable over time.
- •Several factors were associated with initiating anticoagulant treatment.
- •A switch to new anticoagulants such as apixaban was observed over time.
Abstract
Background
Patients with venous thromboembolism (VTE) and cancer are at higher risk of recurrent
VTE and mortality. Clinical guidelines recommend anticoagulant treatment for these
patients. This study assessed trends in outpatient anticoagulant treatment and factors
associated with this treatment initiation in outpatient setting among this high-risk
patient population.
Objective
To study trends and factors associated with anticoagulant treatment initiation among
patients with VTE and cancer.
Methods
VTE cancer patients age ≥65 were identified from the SEER-Medicare database from 01JAN2014-31DEC2019.
Patients were enrolled for ≥6 months prior to their first VTE (i.e. index event) and
without evidence of other reasons for anticoagulation (i.e., atrial fibrillation).
Patients were also required to be enrolled for ≥30 days after index. Cancer status
was identified from SEER or Medicare database in the 6 months pre- through 30 days
post-VTE. Patients were classified into treated or untreated cohorts depending on
whether they initiated outpatient anticoagulant treatment within 30 days post-index.
The trends of treated vs. untreated were evaluated by quarter. Logistic regression
was used to identify demographic-, VTE-, cancer- and comorbid-related factors associated
with anticoagulant treatment initiation.
Results
A total of 28,468 VTE-cancer patients met all study criteria. Of these, ~46 % initiated
outpatient anticoagulant treatment within 30 days, and ~54 % did not. The above rates
were stable from 2014 to 2019. Factors such as VTE diagnosis in inpatient setting,
pulmonary embolism (PE) diagnosis, and pancreatic cancer were associated with increased
odds whereas bleeding history and some comorbid factors were associated with decreased
odds of initiating anticoagulant treatment.
Conclusion
Over half of VTE patients with cancer did not initiate outpatient anticoagulant treatment
within the first 30-days after VTE diagnosis. This trend was stable from 2014 to 2019.
A range of cancer-, VTE-, and comorbid-related factors were associated with the likelihood
of the treatment initiation.
Keywords
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Article info
Publication history
Published online: February 14, 2023
Accepted:
February 3,
2023
Received in revised form:
January 30,
2023
Received:
October 6,
2022
Identification
Copyright
© 2023 Published by Elsevier Ltd.
