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March 22, 2023JAMA Network OpenOpen Access

Trends in the Use of Oral Anticoagulants for Adults With Venous Thromboembolism in the US, 2010-2020

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Why the study?

DOACs have transformed VTE treatment, but understanding real-world prescribing patterns and clinical events that precede treatment changes is needed.

What are the prescribing patterns, temporal trends, and reasons for treatment modification of oral anticoagulants in adults with VTE in the US?

Population

298 609 patients initiating OACs within 90 days of index VTE hospitalization

Comparison

Warfarin vs DOACs (rivaroxaban, apixaban, dabigatran, edoxaban)

Design

Retrospective cohort study

Authors

GIGeetha IyerHarvard UniversityHTHelen TesfayeBrigham and Women's HospitalNKNazleen F. KhanBrigham and Women's Hospital

Discussion

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Implication

DOAC uptake now dominates VTE initiation; extends real-world trends data while leaving persistence and outcome effects open.

Structured PICO

What are the prescribing patterns, temporal trends, and reasons for treatment modification of oral anticoagulants in adults with VTE in the US?

P
Population
298,609 adults initiating oral anticoagulants within 90 days of index venous thromboembolism (VTE) hospitalization (203,378 Medicare patients, mean age 76.9, 60.3% women; 95,231 commercially insured patients, mean age 57.6, 49.5% women).
I
Intervention
Oral anticoagulants (warfarin, rivaroxaban, apixaban, dabigatran, edoxaban)
O
Outcome
Characteristics of patients initiating different OACs, trends over time of patients initiating OACs, time receiving continuous anticoagulant therapy, patterns of anticoagulant discontinuation (treatment gap of ≥30 days), and treatment switches

DOACs have largely replaced warfarin for VTE treatment in the US, accounting for over 85% of initiations by 2019-2020, with most patients persisting on therapy for about 6 months.

Cite This Study

Iyer et al. (2023) studied this question.

synapsesocial.com/papers/69982c24be1be0234d32ff64https://doi.org/10.1001/jamanetworkopen.2023.4059

Topics

Anticoagulation in AF
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Trends in the prescription of novel oral anticoagulants in UK primary care2017 · 245 citations
  2. 2Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism2013 · 1,884 citations
  3. 3Thirteen-year trend in the persistence with vitamin K antagonists for venous thromboembolism in the UK: a cohort study2018 · 2 citations
  4. 4Oral Rivaroxaban for Symptomatic Venous Thromboembolism2010 · 3,277 citations
  5. 5Oral Apixaban for the Treatment of Acute Venous Thromboembolism2013 · 2,337 citations