Clinical characteristics and treatment patterns of patients with venous thromboembolism (VTE) transitioning from hospital to post-discharge settings

ABSTRACT

Objective

This study examined anticoagulant use during and after a hospital encounter for venous thromboembolism (VTE), a transition of care largely uncharacterized in the literature.

Methods

Adults with a VTE diagnosis code during a hospital encounter (emergency department [ED], observation area [OBS], or inpatient hospital [IP]) from January 2012 to August 2017 were identified in an electronic health records database. The first such hospital encounter was defined as the index VTE encounter. Patients were linked to a claims database and required to be continuously enrolled for six months before the index admission date through six months after the index discharge date. Anticoagulants administered during the index VTE encounter and filled on or within 30 days of discharge were summarized descriptively overall, and by the type of index VTE encounter (IP, No IP) and anticoagulants administered during the index VTE encounter.

Results

Among 2,968 eligible patients, mean (SD) age was 64 (16) years, 51% were female, 67% had an IP index VTE encounter, and 77% received anticoagulation therapy during the index VTE encounter. In total, 60% filled a prescription order for anticoagulant within 30 days post-discharge. Of those who received a direct oral anticoagulant (DOAC), warfarin, or parenteral anticoagulant only during the index VTE encounter, 74%, 69%, and 34%, respectively, filled a prescription for the same anticoagulant post-discharge. Patients treated with a DOAC or warfarin during an ED or OBS VTE encounter without a subsequent inpatient hospitalization were more likely to remain on the same anticoagulation therapy post-discharge than those with an inpatient hospitalization (81% vs 69% for DOAC and 75% vs 68% for warfarin).

Conclusions

Many patients treated with anticoagulation therapy during a VTE hospital encounter did not fill a prescription for an anticoagulant within 30 days post-discharge, highlighting an opportunity for improved management of care transitions in this patient population.

KEYWORDS:

• Venous thromboembolism
• oral anticoagulation
• direct oral anticoagulants
• transition of care
• apixaban
• warfarin

Acknowledgments

The authors wish to acknowledge Jen Wogen (MedMentis Consulting LLC, Farmington, CT) and Yvette Edmonds, PhD (Optum) for editorial assistance.

Declaration of interest

This study was funded by Pfizer, Inc. and Bristol-Myers Squibb Company.

Tanya Burton is an employee of Optum, which was contracted by Pfizer, Inc. and Bristol-Myers Squibb Company to conduct this study.

P. Hlavacek, C Russ and J Mardekian are employees of Pfizer.

J D Guo, L Rosenblatt and M Ferri are employees of Bristol-Myers Squibb.

J A Kline has received funding from Pfizer and Bristol-Myers Squibb.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

Availability of data and materials: The data contained in our database contains proprietary elements owned by Optum, and therefore cannot be broadly disclosed or made publicly available at this time. The disclosure of this data to third-party clients assumes that certain data security and privacy protocols are in place and the third-party client has executed our standard license agreement, which includes restrictive covenants governing the use of the data.