Key result
African American race was associated with lower optimal medication adherence for anticoagulation after acute pulmonary embolism (Adjusted OR 0.166; 95% CI 0.033-0.837; P=0.030).
Why the study?
Anticoagulation adherence after acute pulmonary embolism is vital to prevent mortality and recurrence of venous thromboembolism, but factors affecting adherence required analysis.
Observational (n=118)
No
Odds Ratio: 0.166 (95% CI 0.033–0.837)
p-value: p=0.030
African American and other minority race patients demonstrate significantly lower adherence to anticoagulation therapy following acute pulmonary embolism.
May warrant targeted adherence support for African American patients post-PE; leaves open whether interventions improve outcomes.
Anticoagulation (AC) adherence after acute pulmonary embolism (PE) is vital to prevent mortality and future recurrence of venous thromboembolism (VTE). We aimed to analyze factors affecting AC adherence after acute PE. Consecutive adult patients with CT angiography or V/Q scan confirmed acute PE were included in a single-center retrospective study from April 2016 to May 2020. Adherence data, including AC refill dates, were collected from pharmacies, and adherence measures including Continuous Measure of Medication Acquisition (CMA), Proportion of Days Covered (PDC), and Optimal Medication Adherence (OMA) were calculated per standardized formulas. Univariable and multivariable linear and logistic regression was used to analyze different variables affecting AC adherence. A total of 118 out of 144 patients had sufficient follow-up data to measure adherence and were included in the final analysis. Mean age was 60 ± 15 years, with 64 (54.2%) women; 70 (59.3%) White, 26 (22%) African American, 13 (11%) Hispanic; 58 (49.2%) patients had private insurance, 48 (40.7%) Medicare, 11 (9.3%) Medicaid. Type of AC comprised of 57 (48.3%) apixaban, 17 (14.4%) rivaroxaban, 8 (6.8%) warfarin, 6 (5.1%) enoxaparin, and 30 (25.4%) patients with changing AC. In univariable regression, African American and Medicaid-insured patients had significantly lower adherence, while advancing age, apixaban usage, and 30-day follow-up clinic visit showed a higher adherence. However, in multivariable regression, African American race (PDC -0.135, p = 0.006, CI (−0.231, −0.040) | OMA Adjusted OR 0.166, p = 0.030, CI (0.033, 0.837)) and other non-White, non-Hispanic races (PDC -0.314, p = 0.009, CI (−0.548, −0.080)) were associated with lower AC adherence. In our study, African American and other minority race patients showed lower AC adherence after hospital admission for acute PE. Further studies are needed to address underlying contributors and improve adherence in this population.
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Merchant et al. (2022) conducted an observational in Acute pulmonary embolism (n=118). African American race vs. White race was evaluated on Optimal Medication Adherence (OMA) (Adjusted OR 0.166, 95% CI 0.033-0.837, p=0.030). African American race was associated with lower optimal medication adherence for anticoagulation after acute pulmonary embolism (Adjusted OR 0.166; 95% CI 0.033-0.837; P=0.030).
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