Predictors of not initiating anticoagulation after incident venous thromboembolism: a Danish nationwide cohort study.
Am J Med. 2019 Oct 10;:
Authors: Albertsen IE, Goldhaber SZ, Piazza G, Overvad TF, Nielsen PB, Larsen TB, Søgaard M
PURPOSE: To investigate potential predictors associated with not initiating anticoagulation after incident venous thromboembolism.
METHODS: We linked Danish nationwide health registries to identify all patients with incident venous thromboembolism from 2003 through 2016. We defined treatment non-initiation as not claiming a prescription for an anticoagulant drug within 30 days after hospital discharge. To identify potential predictors of non-initiation, relative risks (RRs) with 95% confidence intervals (CIs) were calculated adjusting for other compliance-related factors.
RESULTS: The study included 38,044 patients with incident venous thromboembolism (53.2% female and median age 66.1 years). Of these, 24.1% (n=9,294) were non-initiators. Demographic and condition-related factors that predicted non-initiation included: female sex (RR 1.30 (95% CI, 1.25-1.34)), age <30 years vs. age >65 (RR 1.18 (95% CI, 1.13-1.33), hospitalization 0-3 days vs. >3 days (RR 1.96 (95% CI 1.87;2.07), incident deep venous thrombosis (RR 1.91 (95% CI 1.81-2.01)), and unprovoked venous thromboembolism (RR 1.13 (95% CI 1.08-1.17). Socioeconomic factors had less influence on risk of non-initiation. Individual chronic diseases predictive of non-initiation included congestive heart failure (RR 1.27 (95% CI 1.17-1.37)), ischemic heart disease (RR 1.20 (95% CI 1.13-1.28)), and liver disease (RR 1.60 (95% CI 1.42-1.81)).
CONCLUSION: Up to one-fourth of patients diagnosed with incident venous thromboembolism did not initiate anticoagulant treatment within 30 days after hospital discharge. Identification of clinical predictors of non-initiation may enable implementation of patient-tailored strategies to improve adherence and thereby potentially prevent venous thromboembolism morbidity, mortality, and recurrence.
PMID: 31606490 [PubMed - as supplied by publisher]