Impact of Oral Anticoagulation Choice on Healthcare Utilization for the Primary Treatment of Venous Thromboembolism

Details

• Personal Author:
  Adam TJ ; Alonso A ; Claxton JS ; Lutsey PL ; MacLehose RF ; Walker RF ; Zakai NA
• Description:
  Little is known about the impact of oral anticoagulation (OAC) choice on healthcare encounters during venous thromboembolism (VTE) primary treatment. Among anticoagulant-naïve patients with VTE, we tested the hypotheses that healthcare utilization would be lower among users of direct OACs (DOACs; rivaroxaban or apixaban) than among users of warfarin. MarketScan databases for years 2016 and 2017 were used; healthcare utilization was identified in the first 6 months after initial VTE diagnoses. The 23,864 patients with VTE had on average 0.2 +/- 0.5 hospitalizations, spent 1.3 +/- 5.2 days in the hospital, had 5.7 +/- 5.1 outpatient encounters, and visited an emergency department 0.4 +/- 1.1 times. As compared to warfarin, rivaroxaban and apixaban were associated with fewer hospitalizations, days hospitalized, outpatient office visits, and emergency department visits after accounting for age, sex, comorbidities, and medications. Hospitalization rates were 24% lower (incidence rate ratio (IRR): 0.76; 95% CI: 0.69, 0.83) with rivaroxaban and 22% lower (IRR: 0.78; 95% CI: 0.71, 0.87) with apixaban, as compared to warfarin (IRR: 1.00 (reference)). Healthcare utilization was similar between apixaban and rivaroxaban users. Patients with VTE prescribed rivaroxaban and apixaban had lower healthcare utilization than those prescribed warfarin, while there was no difference when comparing apixaban to rivaroxaban. These findings complement existing literature supporting the use of DOACs over warfarin. [Description provided by NIOSH]
• Subjects:
  Blood Delivery Of Health Care Drug Therapy Occupational Health Safety
• Keywords:
  Anticoagulants Apixaban Author Keywords: Anticoagulation Blood Disorders Blood Vessels Circulatory System Drug Therapy Health Care Healthcare Utilization Medical Care Medicinal Chemicals Rivaroxaban Venous Thromboembolism VTE

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• ISSN:
  1358-863X
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Minnesota ; OSHA Region 1 ; OSHA Region 4 ; OSHA Region 5 ; Vermont
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  25
• Issue:
  6
• NIOSHTIC Number:
  nn:20064504
• Citation:
  Vasc Med 2020 Dec; 25(6):549-556
• Contact Point Address:
  Pamela L Lutsey, Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN 55454, USA
• Email:
  lutsey@umn.edu
• CAS Registry Number:
  (±)-Warfarin (CAS RN 81-81-2) ; Apixaban (CAS RN 503612-47-3) ; Rivaroxaban (CAS RN 366789-02-8)
• Federal Fiscal Year:
  2021
• Performing Organization:
  University of Minnesota Twin Cities
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Vascular Medicine
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f3b6e6bf8d90ab55a6071de3b1e35992e4e4d3a57f1338b3dda4cbd21cdb07110b4de17f847b3d6cc466adcf5bfbbe38dfd927512ec7040b27fb31f8a563660f
• Download URL:
  https://stacks.cdc.gov/view/cdc/222954/cdc_222954_DS1.pdf
• File Type:
  [PDF - 145.75 KB ]