Key result
LMWH and UFH were the most common initial inpatient treatments for cancer-associated thrombosis, but DOACs were the most common post-discharge therapy (40.3%) and demonstrated higher 3-month persistence than LMWH (87.8% vs 53.0%).
Why the study?
Little is known about the current real-world utilization of DOACs in cancer-associated thrombosis patients, particularly during the transition from inpatient to outpatient therapy.
Cohort (n=8,125)
Yes
DOACs are increasingly used as an inpatient/ED treatment option for cancer-associated thrombosis and are associated with less post-discharge treatment switching and higher persistence and adherence compared to LMWH.
DOACs may support higher post-discharge persistence in cancer-associated thrombosis; leaves open need for randomized trials to guide practice.
Low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are among the recommended treatment options for cancer-associated thrombosis (CAT) in the 2019 National Comprehensive Care Network guidelines. Little is known about the current utilization of DOACs in CAT patients, particularly on the inpatient to outpatient therapy transition. This study assessed real-world treatment patterns of CAT in hospital/ED in adult cancer patients (≥ 18 years) diagnosed with CAT during a hospital visit in IQVIA's Hospital Charge Data Master database between July 1, 2015 and April 30, 2018, and followed their outpatient medical and pharmacy claims to evaluate the initial inpatient/ED and outpatient anticoagulants received within 3 months post-discharge. Results showed that LMWH and unfractionated heparin (UFH) were the most common initial inpatient/ED CAT treatments (35.2% and 27.4%, respectively), followed by DOACs (9.6%); 20.8% of patients received no anticoagulants. Most DOAC patients remained on DOACs from inpatient/ED to outpatient settings (71.4%), while 24.1%, 43.5%, and 0.1% of patients treated with LMWH, warfarin, or UFH respectively, remained on the same therapy after discharge. In addition, DOACs were the most common initial post-discharge outpatient therapy. Outpatient treatment persistence and adherence appeared higher in patients using DOACs or warfarin versus LMWH or UFH. This study shows that DOACs are used as an inpatient/ED treatment option for CAT, and are associated with less post-discharge treatment switching and higher persistence and adherence. Further research generating real-world evidence on the role of DOACs to help inform the complex CAT clinical treatment decisions is warranted.
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Guo et al. (2020) conducted a cohort in Cancer-associated thrombosis (CAT) (n=8,125). Anticoagulant therapy (DOACs, LMWH, Warfarin, UFH) vs. Comparisons between anticoagulant classes was evaluated on Anticoagulant treatment patterns (initial inpatient/ED use and post-discharge persistence/adherence). LMWH and UFH were the most common initial inpatient treatments for cancer-associated thrombosis, but DOACs were the most common post-discharge therapy (40.3%) and demonstrated higher 3-month persistence than LMWH (87.8% vs 53.0%).
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