PMID- 31955338
OWN - NLM
STAT- MEDLINE
DCOM- 20210607
LR  - 20210607
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 50
IP  - 2
DP  - 2020 Aug
TI  - Inpatient and outpatient treatment patterns of cancer-associated thrombosis in 
      the United States.
PG  - 386-394
LID - 10.1007/s11239-019-02032-3 [doi]
AB  - Low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are 
      among the recommended treatment options for cancer-associated thrombosis (CAT) in 
      the 2019 National Comprehensive Care Network guidelines. Little is known about 
      the current utilization of DOACs in CAT patients, particularly on the inpatient 
      to outpatient therapy transition. This study assessed real-world treatment 
      patterns of CAT in hospital/ED in adult cancer patients (>/= 18 years) diagnosed 
      with CAT during a hospital visit in IQVIA's Hospital Charge Data Master database 
      between July 1, 2015 and April 30, 2018, and followed their outpatient medical 
      and pharmacy claims to evaluate the initial inpatient/ED and outpatient 
      anticoagulants received within 3 months post-discharge. Results showed that LMWH 
      and unfractionated heparin (UFH) were the most common initial inpatient/ED CAT 
      treatments (35.2% and 27.4%, respectively), followed by DOACs (9.6%); 20.8% of 
      patients received no anticoagulants. Most DOAC patients remained on DOACs from 
      inpatient/ED to outpatient settings (71.4%), while 24.1%, 43.5%, and 0.1% of 
      patients treated with LMWH, warfarin, or UFH respectively, remained on the same 
      therapy after discharge. In addition, DOACs were the most common initial 
      post-discharge outpatient therapy. Outpatient treatment persistence and adherence 
      appeared higher in patients using DOACs or warfarin versus LMWH or UFH. This 
      study shows that DOACs are used as an inpatient/ED treatment option for CAT, and 
      are associated with less post-discharge treatment switching and higher 
      persistence and adherence. Further research generating real-world evidence on the 
      role of DOACs to help inform the complex CAT clinical treatment decisions is 
      warranted.
FAU - Guo, J D
AU  - Guo JD
AUID- ORCID: 0000-0001-7975-4056
AD  - Bristol-Myers Squibb, 3401 Princeton Pike, Lawrence Township, Lawrenceville, NJ, 
      08648, USA. Jennifer.Guo@bms.com.
FAU - Hlavacek, P
AU  - Hlavacek P
AD  - Pfizer, Inc., New York, NY, USA.
FAU - Poretta, T
AU  - Poretta T
AD  - Bristol-Myers Squibb, 3401 Princeton Pike, Lawrence Township, Lawrenceville, NJ, 
      08648, USA.
FAU - Wygant, G
AU  - Wygant G
AD  - Bristol-Myers Squibb, 3401 Princeton Pike, Lawrence Township, Lawrenceville, NJ, 
      08648, USA.
FAU - Lane, D
AU  - Lane D
AD  - Bristol-Myers Squibb, 3401 Princeton Pike, Lawrence Township, Lawrenceville, NJ, 
      08648, USA.
FAU - Gorritz, M
AU  - Gorritz M
AD  - IQVIA Inc, Plymouth Meeting, PA, USA.
FAU - Wang, X
AU  - Wang X
AD  - IQVIA Inc, Plymouth Meeting, PA, USA.
FAU - Chen, C C
AU  - Chen CC
AD  - IQVIA Inc, Plymouth Meeting, PA, USA.
FAU - Wade, R L
AU  - Wade RL
AD  - IQVIA Inc, Plymouth Meeting, PA, USA.
FAU - Pan, X
AU  - Pan X
AD  - Bristol-Myers Squibb, 3401 Princeton Pike, Lawrence Township, Lawrenceville, NJ, 
      08648, USA.
FAU - Rajpura, J
AU  - Rajpura J
AD  - Bristol-Myers Squibb, 3401 Princeton Pike, Lawrence Township, Lawrenceville, NJ, 
      08648, USA.
FAU - Stwalley, B
AU  - Stwalley B
AD  - Bristol-Myers Squibb, 3401 Princeton Pike, Lawrence Township, Lawrenceville, NJ, 
      08648, USA.
FAU - Rosenblatt, L
AU  - Rosenblatt L
AD  - Bristol-Myers Squibb, 3401 Princeton Pike, Lawrence Township, Lawrenceville, NJ, 
      08648, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Ambulatory Care/*trends
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Databases, Factual
MH  - Drug Substitution/trends
MH  - Drug Utilization/trends
MH  - Factor Xa Inhibitors/therapeutic use
MH  - Female
MH  - Heparin/therapeutic use
MH  - Humans
MH  - *Inpatients
MH  - Male
MH  - Medication Adherence
MH  - Middle Aged
MH  - Neoplasms/diagnosis/*drug therapy/epidemiology
MH  - Patient Discharge/trends
MH  - Practice Patterns, Physicians'/*trends
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States/epidemiology
MH  - Venous Thrombosis/diagnosis/*drug therapy/epidemiology
MH  - Warfarin/therapeutic use
PMC - PMC7366581
OTO - NOTNLM
OT  - Cancer
OT  - Cancer associated thrombosis
OT  - Direct oral anticoagulants
OT  - Low molecular weight heparin
OT  - Venous thromboembolism
OT  - Warfarin
COIS- Guo JD, Wygant G, Pan X, Rajpura J, Stwalley B, and Rosenblatt L are employees of 
      Bristol-Myers Squibb which provided funding for this study. Lane D was an 
      employee of Bristol-Myers Squibb at the time this study was conducted. Poretta T 
      is an employee of Rutgers University and a consultant of Bristol-Myers Squibb. 
      Hlavacek P is an employee of Pfizer, Inc. Gorritz M, Wang X, Chen CC, and Wade RL 
      are employees of IQVIA, Inc, which received funding from Bristol-Myers Squibb to 
      conduct this study.
EDAT- 2020/01/20 06:00
MHDA- 2021/06/08 06:00
PMCR- 2020/01/18
CRDT- 2020/01/20 06:00
PHST- 2020/01/20 06:00 [pubmed]
PHST- 2021/06/08 06:00 [medline]
PHST- 2020/01/20 06:00 [entrez]
PHST- 2020/01/18 00:00 [pmc-release]
AID - 10.1007/s11239-019-02032-3 [pii]
AID - 2032 [pii]
AID - 10.1007/s11239-019-02032-3 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2020 Aug;50(2):386-394. doi: 10.1007/s11239-019-02032-3.