A descriptive study of antithrombotic medication patterns in adult patients with recent venous thromboembolism
Objectives: The objective of this study is to describe the most common self-reported antithrombotic therapy utilization patterns in a national cohort of patients with recent venous thromboembolism (VTE).
Methods: Extant data from a national online survey administered to 907 patients 18 years of age or older with VTE in the last two years were analyzed. Patients’ self-reported antithrombotic usage patterns used during three phases of treatment for the most recent VTE episode were summarized using descriptive statistics.
Results: The following overall antithrombotic usage patterns were identified: warfarin (38.7%), direct oral anticoagulants (DOACs) (26.1%), switching between warfarin and DOACs (13.3%), aspirin only (8.7%), switching between different DOACs (4.5%), injectable anticoagulants only (3.9%), and no treatment (4.7%). Extended antithrombotic therapy beyond 90 days was reported by 65.7% of patients. Aspirin coadministration with anticoagulant therapy occurred for 33.7%.
Conclusions: In this national sample of recent VTE sufferers warfarin therapy remains the most used anticoagulant followed closely by DOAC therapy. Switching between warfarin and DOACs and between different DOACs was common which could indicate adverse events or affordability issues. Aspirin coadministration with anticoagulant therapy was present in 1 of 3 patients and is a potential medication safety intervention for anticoagulation providers.
Thaler J, Pabinger I, Ay C. Anticoagulant treatment of deep vein thrombosis and pulmonary embolism: the present state of the art. Front Cardiovasc Med. 2015;2:30. https://doi.org/10.3389/fcvm.2015.00030
Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):3-14. https://doi.org/10.1007/s11239-015-1311-6
Casciano JP, Dotiwala Z, Kemp R, Li C, Cai J, Preblick R. Economic burden of recurrent venous thromboembolism: analysis from a U.S. hospital perspective. Am J Health Syst Pharm. 2015;72(4):291-300. https://doi.org/10.2146/ajhp140204
Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores L. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149(2):315-352. https://doi.org/10.1016/j.chest.2015.11.026
Witt DM, Clark NP, Kaatz S, Schnurr T, Ansell JE. Guidance for the practical management of warfarin therapy in the treatment of venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):187-205. https://doi.org/10.1007/s11239-015-1319-y
Alalwan AA, Voils SA, Hartzema AG. Trends in utilization of warfarin and direct oral anticoagulants in older adult patients with atrial fibrillation. Am J Health Syst Pharm. 2017;74(16):1237-1244. https://doi.org/10.2146/ajhp160756
Nathan A, Geng Z, Raman S, Dayoub E, Adusumalli S, Geller B, Kobayashi T, Giri J, Groeneveld P. Trends in oral anticoagulant use for the treatment of venous thromboembolism in the United States, 2010-2016. Paper presented at: ACC.19: The American College of Cardiology 68th Annual Scientific Sessions; New Orleans, LA, March 16-18, 2019. https://doi.org/10.1016/S0735-1097(19)32716-0
Garber MC, Nau DP, Erickson SR, Aikens JE, Lawrence JB. The concordance of self-report with other measures of medication adherence: a summary of the literature. Med Care. 2004;42(7):649-652. https://doi.org/10.1097/01.mlr.0000129496.05898.02
Caskie GI, Willis SL, Warner Schaie K, Zanjani FA. Congruence of medication information from a brown bag data collection and pharmacy records: findings from the Seattle longitudinal study. Exp Aging Res. 2006;32(1):79-103. https://doi.org/10.1080/03610730500326341
Caskie GI, Willis SL. Congruence of self-reported medications with pharmacy prescription records in low-income older adults. Gerontologist. 2004;44(2):176-185. https://doi.org/10.1093/geront/44.2.176
Feehan M, Walsh M, Van Duker H, Godin J, Munger MA, Fleming R, Johnson SA, Morrison MA, DeAngelis MM, Witt DM. Prevalence and correlates of bleeding and emotional harms in a national US sample of patients with venous thromboembolism: A cross-sectional structural equation model. Thromb Res. 2018;172:181-187. https://doi.org/10.1016/j.thromres.2018.05.025
Jones AE, Feehan M, Fleming R, Johnson SA, Witt DM. Outcomes associated with a change in clinical practice to alleviate emotional harm related to venous thromboembolism. Thromb Res. 2019;180:29-31. https://doi.org/10.1016/j.thromres.2019.05.022
Pulleyn T, Kim K, Witt DM, Feehan M, Munger MA. Understanding patients' care barriers in the treatment of venous thromboembolism. J Thromb Thrombolysis. 2019;48(1):35-41. https://doi.org/10.1007/s11239-019-01880-3
Bristol Myers Squibb C. Eliquis Prescribing Information. http://packageinserts.bms.com/pi/pi_eliquis.pdf (accessed Aug 3, 2019).
Daiichi Sankyo I. Savaysa Prescribing Information. http://dsi.com/prescribing-information-portlet/getPIContent?productName=Savaysa&inline=true (accessed Aug 3, 2019).
Janssen Pharmaceuticals I. Xarelto Prescribing Information. https://www.xareltohcp.com/shared/product/xarelto/prescribing-information.pdf (accessed Aug 3, 2019).
Johnson SG, Rogers K, Delate T, Witt DM. Outcomes associated with combined antiplatelet and anticoagulant therapy. Chest. 2008;133(4):948-954. https://doi.org/10.1378/chest.07-2627
Johnson SG, Witt DM, Eddy TR, Delate T. Warfarin and antiplatelet combination use among commercially insured patients enrolled in an anticoagulation management service. Chest. 2007;131(5):1500-1507. https://doi.org/10.1378/chest.06-2374
January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104-132. https://doi.org/10.1016/j.jacc.2019.01.011
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.