Physicians Favor Old Faithful for Deep Vein Thrombosis and Pulmonary Embolism Treatment

A new treatment option for deep vein thrombosis (DVT) and pulmonary embolism (PE) was recently introduced, but it looks like old habits die hard when it comes to prescriptions.

Despite a new drug arriving on the scene, the dominant treatment for DVT and PE appears to remain the same. Researchers from Boston Health Economics, Inc. and Boehringer Ingelheim Pharmaceuticals Inc. evaluated demographics and clinical characteristics to identify treatment patterns in patients with DVT and/or PE. They discussed the findings during a poster session at the 57^th American Society of Hematology Annual Meeting (ASH 2015) in Orlando, Florida.

The analysis included 46,214 patients who had been diagnosed with DVT or PE from November 1, 2013 to December 31, 2013 — during the time when rivaroxaban was approved for both conditions. Patients were at least 18 years of age with the average being 61. Fifty-three percent of the cohort was female and none of the patients had a secondary condition that was primarily treated with an anticoagulant. All of the participants had completed a hospital stay as a result of their condition (which is when they were first diagnosed).

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The researchers used a logistical regression to determine how likely patients were to receive rivaroxaban with parenteral anticoagulant (PAC) and/or warfin compared to just rivaroxaban by itself. They adjusted the findings for demographics, hospital characteristics, and clinical data. Patients’ anticoagulant treatments were as followed:

• 70%: PAC + warfarin
• 16%: PAC alone
• 6%: PAC + rivaroxaban
• 4%: PAC + warfarin + rivaroxaban
• 1%: Warfarin alone
• 1%: Rivaroxaban alone
• 2%: No anticoagulant therapy

Of the patients who were prescribed rivaroxaban, 90% were also given PAC. Patients were significantly less likely to receive rivaroxaban with PAC and/or warfarin if they were female, lived in the Midwest when compared to the South, had a history of DVT or PE when compared to those with no history, or were seen by a hospitalist or family practitioner when compared to internal medicine. On the other hand, patients were significantly more likely to receive the combination of drugs if they were diagnosed with primary PE or primary DVT with secondary PE, had renal disease, or received care at an urban hospital.

“Our findings indicate that the standard of care (PAC + warfarin) remains the dominant treatment regimen (95.7% of regimens included PAC) despite the availability of rivaroxaban,” the authors concluded.

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