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Adherence to guidelines for oral anticoagulation after venous thrombosis and pulmonary embolism

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Abstract

OBJECTIVE: Guidelines for oral anticoagulation after deep venous thrombosis (DVT) or pulmonary embolism (PE) have recommended that patients be anticoagulated for at least 3 months after hospital discharge. We sought to determine whether this recommendation was being followed and what patient characteristics predict a shorter than recommended duration of therapy.

DESIGN: Retrospective cohort study using linked health care claims data.

SETTING: Routine clinical practice.

PATIENTS: Five hundred seventy-three members of New Jersey’s Medicaid or Pharmacy Assistance for the Aged and Disabled programs aged 65 years and older who were hospitalized for DVT or PE between January 1, 1991 and June 30, 1994.

RESULTS: Of the 573 patients, 129 (23%) filled prescriptions covering less than 90 days of oral anticoagulant therapy. In multivariate models, African-American race was associated with an increased risk of a shorter than recommended duration of therapy (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.14 to 3.08), but age and gender were not. Patients who used anticoagulants in the year prior to admission were less likely to have a short duration of therapy (OR, 0.30; 95% CI, 0.12 to 0.78), than were patients with PE (OR, 0.58; 95% CI, 0.38 to 0.88).

CONCLUSIONS: Nearly a quarter of those anticoagulated following DVT or PE received therapy for less than the recommended length of time after hospital discharge, with African Americans more likely to have a shorter than recommended course of treatment. Further research is needed to evaluate the causes of shorter than recommended duration of therapy and racial disparities in anticoagulant use.

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Authors and Affiliations

  1. the Program for the Analysis of Clinical Strategies, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass

    David A. Ganz BA, Robert J. Glynn PhD, ScD, Helen Mogun MS, Eric L. Knight MD, MPH, Rhonda L. Bohn ScD &  Jerry Avorn MD (Chief)

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  1. David A. Ganz BA
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  2. Robert J. Glynn PhD, ScD
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  3. Helen Mogun MS
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  4. Eric L. Knight MD, MPH
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  5. Rhonda L. Bohn ScD
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  6. Jerry Avorn MD
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Corresponding author

Correspondence to Jerry Avorn MD.

Additional information

David Ganz was supported in part by a research scholarship in geriatric pharmacology from the American Federation for Aging Research and the Merck Foundation. This work was also supported by core funding to the Division of Pharmacoepidemiology and Pharmacoeconomics from the Brigham and Women’s Hospital.

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Ganz, D.A., Glynn, R.J., Mogun, H. et al. Adherence to guidelines for oral anticoagulation after venous thrombosis and pulmonary embolism. J GEN INTERN MED 15, 776–781 (2000). https://doi.org/10.1046/j.1525-1497.2000.91022.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2000.91022.x

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