Roxanne Dault1, Alain Vanasse1,2, Lucie Blais2,3,4, Sylvie Perreault3, Paul Farand2,5, Geneviève Le Templier6, Marie-France Beauchesne7,2,3,8. 1. Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada. 2. Research Center, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. 3. Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada. 4. Research Center, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada. 5. Department of Cardiology, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. 6. Department of Internal Medicine, Centre hospitalier universitaire de Sherbrooke, Quebec, Canada. 7. Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada marie-france.beauchesne@umontreal.ca. 8. Department of Pharmacy, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
Abstract
BACKGROUND: Few studies have identified patterns and predictors of use of direct oral anticoagulants for venous thromboembolism (VTE). OBJECTIVE: To describe the use of anticoagulants and assess predictors associated with the prescription of rivaroxaban over vitamin K antagonist (VKA) for the subsequent treatment of VTE. METHODS: This cross-sectional study was built with all consecutive patients newly diagnosed with acute VTE admitted between February 18, 2013, and September 18, 2013, in an academic tertiary care center in Quebec, Canada. Patient characteristics and VTE treatments were described. Univariate analyses and a multiple forward stepwise logistic regression were performed to assess predictors of rivaroxaban use over VKA for the subsequent treatment of VTE. RESULTS: The study included 256 patients, 36.7% with a diagnosis of deep vein thrombosis (DVT) and 63.3% with pulmonary embolism (PE). Mean age was 63.1 years, and 28.1% of patients had cancer-associated VTE. Overall, rivaroxaban was prescribed in 1.6% of patients for the initial treatment and in nearly 20% of patients for the subsequent treatment of VTE. Low-molecular-weight heparin and VKA were mostly prescribed. Independent predictors associated with the prescription of rivaroxaban over VKA were as follows: age < 65 years (OR: 2.86, 95% CI 1.29-6.37), a diagnosis of DVT versus PE (OR 2.54, 95% CI 1.20-5.40), and an emergency department visit rather than a hospitalization (OR 2.24, 95% CI 1.06-4.71). CONCLUSION: Several months following its availability, rivaroxaban was rarely prescribed for acute VTE disease. It also appears to be prescribed in different patient populations than VKA.
BACKGROUND: Few studies have identified patterns and predictors of use of direct oral anticoagulants for venous thromboembolism (VTE). OBJECTIVE: To describe the use of anticoagulants and assess predictors associated with the prescription of rivaroxaban over vitamin K antagonist (VKA) for the subsequent treatment of VTE. METHODS: This cross-sectional study was built with all consecutive patients newly diagnosed with acute VTE admitted between February 18, 2013, and September 18, 2013, in an academic tertiary care center in Quebec, Canada. Patient characteristics and VTE treatments were described. Univariate analyses and a multiple forward stepwise logistic regression were performed to assess predictors of rivaroxaban use over VKA for the subsequent treatment of VTE. RESULTS: The study included 256 patients, 36.7% with a diagnosis of deep vein thrombosis (DVT) and 63.3% with pulmonary embolism (PE). Mean age was 63.1 years, and 28.1% of patients had cancer-associated VTE. Overall, rivaroxaban was prescribed in 1.6% of patients for the initial treatment and in nearly 20% of patients for the subsequent treatment of VTE. Low-molecular-weight heparin and VKA were mostly prescribed. Independent predictors associated with the prescription of rivaroxaban over VKA were as follows: age < 65 years (OR: 2.86, 95% CI 1.29-6.37), a diagnosis of DVT versus PE (OR 2.54, 95% CI 1.20-5.40), and an emergency department visit rather than a hospitalization (OR 2.24, 95% CI 1.06-4.71). CONCLUSION: Several months following its availability, rivaroxaban was rarely prescribed for acute VTE disease. It also appears to be prescribed in different patient populations than VKA.
Authors: Chi Zhang; Bo Xu; Guanzhao Liang; Xianshang Zeng; Chen Yang; Fan Zhang; Zi Wan; Weiguang Yu; Deng Chen; Zhe Ge; Xinchao Zhang Journal: J Int Med Res Date: 2018-03-21 Impact factor: 1.671