Predictors of not initiating anticoagulation after incident venous thromboembolism: a Danish nationwide cohort study

Ida Ehlers Albertsen, Samuel Zachary Goldhaber, Gregory Piazza, Thure Filskov Overvad, Peter Brønnum Nielsen, Torben Bjerregaard Larsen, Mette Søgaard

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4 Citations (Scopus)

Abstract

Purpose: The purpose of this study was 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 noninitiation as not claiming a prescription for an anticoagulant drug within 30 days after hospital discharge. To identify potential predictors of noninitiation, 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 = 9294) were noninitiators. Demographic and condition-related factors that predicted noninitiation included: female sex (RR 1.30; 95% CI, 1.25-1.34), age <30 vs age >65 years (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 noninitiation. Individual chronic diseases predictive of noninitiation 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 noninitiation may enable implementation of patient-tailored strategies to improve adherence and thereby potentially prevent venous thromboembolism morbidity, mortality, and recurrence.

Original languageEnglish
JournalThe American Journal of Medicine
Volume133
Issue number4
Pages (from-to)463-472.E5
Number of pages15
ISSN0002-9343
DOIs
Publication statusPublished - 1 Apr 2020

Keywords

  • Adherence
  • Anticoagulation
  • Compliance
  • Treatment
  • Venous thromboembolism
  • Humans
  • Middle Aged
  • Risk Factors
  • Male
  • Hospitalization
  • Anticoagulants/therapeutic use
  • Socioeconomic Factors
  • Incidence
  • Venous Thromboembolism/drug therapy
  • Denmark/epidemiology
  • Medication Adherence
  • Adult
  • Female
  • Aged
  • Cohort Studies

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