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Anticoagulant therapies for acute venous thromboembolism among a cohort of patients discharged from Canadian urban and rural hospitals
  1. Tammy J Bungard1,
  2. Bruce Ritchie2,
  3. Jennifer Bolt3,
  4. William M Semchuk3
  1. 1 Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Division of Hematology, University of Alberta, Edmonton, Alberta, Canada
  3. 3 Pharmacy Services, Regina Qu’Appelle Health Region, Regina, Saskatchewan, Canada
  1. Correspondence to Dr Tammy J Bungard; tammy.bungard{at}ualberta.ca

Abstract

Objective To determine anticoagulant therapy at hospital discharge for patients with acute venous thromboembolism (VTE) and secondarily, to describe factors affecting choice of therapy.

Design A retrospective chart review.

Setting Canadian hospitals in Edmonton, Alberta (n=4), Regina, Saskatchewan (n=2) and rural Alberta (n=3) from April 2014 to March 2015.

Participants All patients discharged with an acute VTE were screened. Those with atypical clots, another indication for anticoagulation, pregnancy/breast feeding or lifespan <3 months were excluded.

Primary and secondary outcomes Primarily, we identified the proportion of patients discharged from hospital with acute VTE that were prescribed either traditional therapy (parenteral anticoagulant±warfarin) or a direct oral anticoagulant (DOAC). Secondarily, management based on setting, therapy choice based on deep vein thrombosis (DVT) versus pulmonary embolism (PE), clot burden and renal function was compared. DOAC dosing was assessed (when prescribed), length of hospital stay based on therapy was compared and planned follow-up in the community was described.

Results Among the 695 patients included, most were discharged following a diagnosis of PE (82.9%) on traditional therapy (parenteral anticoagulant±warfarin) (70.2%) with follow-up by either a family doctor (51.5%) or specialist/clinic (46.9%) postdischarge. Regional variation was most evident between urban and rural sites. Of those prescribed a DOAC (28.3%), the majority were dosed appropriately (85.8%). DOAC use did not differ between those with DVT and PE, was proportionately higher for less severe clots and declined with worsening renal function. Patients prescribed DOACs versus traditional therapy had a shorter length of stay (4 vs 7 days, respectively).

Conclusions Uptake of DOAC therapy for acute VTE was modest and may have been influenced by the timing of the audit in relation to the approval of these agents for this indication. Future audits should occur to assess temporal changes and ongoing appropriateness of care delivery.

  • anticoagulation
  • clinical audit
  • thromboembolism

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors TJB contributed to the design of the work, the acquisition, analysis and interpretation of the data. TJB drafted the original manuscript, approved the final version to be published and is accountable for all aspects of the work related to accuracy or integrity. BR contributed to the design of the work, the interpretation of the data and critically revised the manuscript. BR approved the final version to be published and is accountable for all aspects of the work related to accuracy or integrity. JB contributed to the acquisition and interpretation of the data, critically revised the manuscript and approved the final version to be published. JB is accountable for all aspects of the work related to accuracy or integrity. WS contributed to the design, acquisition and interpretation of the data, critically revised the manuscript and approved the final version to be published. WS is also accountable for the accuracy and integrity of this work.

  • Funding Funding was received from Pfizer Canada (via TJB) in the form of an unrestricted grant.

  • Competing interests TJB has received honoraria for an advisory board for Boehringer Ingelheim, as well as honoraria for speaking from Bayer. TJB has received unrestricted grants from Pfizer and Leo Pharma Canada. BR has served on advisory boards, given sponsored lectures using his own slides and received travel expense remuneration for Bayer, Baxter, Beohringer-Ingelheim, CSL-Behring, Pfizer, Sanofi, Servier and Shire. In lieu of honoraria for these activities, the companies have given financial contributions to the University of Alberta. BR reports grants from Novo Nordisk, CSL-Behring and Baxter, all outside of this submitted work. JB has received speaker honoraria from Boehringer Ingleheim in the past 2 years. WS has received honoraria from Bayer, Pfizer, Bristol Myers Squibb and Boehringer Ingleheim. He has served as a consultant or on an advisory board for Bayer and Pfizer/Bristol Myers Squibb and he has received an unrestricted research grant from Pfizer.

  • Patient consent Not required.

  • Ethics approval Health Research Ethics Board approval was received through the University of Alberta (Pro00056384) for all Alberta sites, and via the Regina Qu’Appelle Health Region (REB 15–65) for the Regina sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There is no data sharing agreement—this is included in the original research article.

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