Anticoagulation therapy patterns for acute treatment of venous thromboembolism in GARFIELD-VTE patients

Sylvia Haas, Walter Ageno, Jeffrey I Weitz, Samuel Z Goldhaber, Alexander G G Turpie, Shinya Goto, Pantep Angchaisuksiri, Joern Dalsgaard Nielsen, Gloria Kayani, Audrey Zaghdoun, Alfredo E Farjat, Sebastian Schellong, Henri Bounameaux, Lorenzo G Mantovani, Paolo Prandoni, Ajay K Kakkar

Abstract

BACKGROUND: Parenteral anticoagulants and vitamin K antagonists (VKAs) have constituted the cornerstone of venous thromboembolism (VTE) treatment. Meanwhile, direct oral anticoagulants (DOACs) provide physicians with an alternative. The Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE observes real-world treatment practices.

OBJECTIVES: Describe initial anticoagulation (AC) treatment patterns in VTE patients who received parenteral AC, VKAs, and/or DOACs within ±30 days of diagnosis.

METHODS: VTE patients were categorized into parenteral AC only, parenteral AC with transition to VKA, VKA only, parenteral AC with transition to DOAC, and DOAC only.

RESULTS: A total of 9647 patients were initiated on AC treatment alone. 4781 (49.6%) patients received DOACs ± parenteral ACs; 3187 (33.0%), VKA ± parenteral ACs; and 1679 (17.4%) parenteral ACs alone. Rivaroxaban was the most frequently used DOAC (79.4%). DOACs were more frequently used in North America/Australia (58.1%), Europe (52.2%), and Asia (47.6%) than in Latin America (29.7%) and the Middle East/South Africa (32.5%). In patients with suspected VTE, most received parenteral AC monotherapy (67.7%). Patients with deep vein thrombosis were more likely to receive DOACs alone than those with pulmonary embolism with or without deep vein thrombosis (36.2% vs 25.9%). Active cancer patients received parenteral AC alone (58.9%), with 25.5% receiving DOAC ± parenteral AC and 12.8% parenteral AC and VKA. A total of 46.5% of pregnant patients received parenteral AC monotherapy, 34.0% were treated with VKA ± parenteral AC, and 19.5% received a DOAC (± parenteral AC).

CONCLUSION: AC treatment patterns vary by patient population, geographic region and site of VTE. Guidelines for AC therapy are not always adhered to.

Original languageEnglish
JournalJournal of thrombosis and haemostasis : JTH
Volume17
Issue number10
Pages (from-to)1694-1706
Number of pages13
ISSN1538-7933
DOIs
Publication statusPublished - Oct 2019

Keywords

  • Aged
  • Aged, 80 and over
  • Anticoagulants/administration & dosage
  • Blood Coagulation/drug effects
  • Drug Utilization/trends
  • Female
  • Guideline Adherence/trends
  • Healthcare Disparities/trends
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'/trends
  • Pregnancy
  • Pulmonary Embolism/blood
  • Registries
  • Time Factors
  • Treatment Outcome
  • Venous Thromboembolism/blood
  • Venous Thrombosis/blood

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