Adherence to Guidelines for Oral Anticoagulation after Venous Thrombosis and Pulmonary Embolism

Authors

  • David A. Ganz BA,

    1. Program for the Analysis of Clinical Strategies, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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  • Robert J. Glynn PhD, ScD,

    1. Program for the Analysis of Clinical Strategies, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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  • Helen Mogun MS,

    1. Program for the Analysis of Clinical Strategies, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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  • Eric L. Knight MD, MPH,

    1. Program for the Analysis of Clinical Strategies, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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  • Rhonda L. Bohn ScD,

    1. Program for the Analysis of Clinical Strategies, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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  • Jerry Avorn MD

    1. Program for the Analysis of Clinical Strategies, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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Address correspondence and reprint requests to Dr. Avorn: Chief, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 221 Longwood Ave., Suite 341, Boston, MA 02115 (e-mail: javorn@rics.bwh.harvard.edu).

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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