Johnson ML, Yande S, Aparasu RR, Wanat M, Toale K. Prevalence and factors associated with the use of direct oral anticoagulants and low molecular weight heparins (LMWH) in cancer patients. Poster presented at the ISPOR 2023 Conference; May 7, 2023. Boston, MA. [abstract] Value Health. 2023 Jun; 26(6 supplement):S377-8. doi: 10.1016/j.jval.2023.03.2121

INTRODUCTION: Venous thromboembolism (VTE) is a fatal comorbidity prevalent in cancer patients. Low-molecular weight heparins (LMWHs) have been the preferred treatment for cancer associated thrombosis (CAT). Direct-oral anticoagulants (DOACs) are a relatively newer drug class used for treating CAT. Treatment guidelines provide inconsistent recommendations. This study aimed to study the prevalence and predictors associated with utilization of these anticoagulation strategies.

METHODS: This retrospective cohort study used SEER Medicare data from years 2011-2019. Patients with lung, pancreatic, breast, colorectal, prostate, and/or stomach cancer, diagnosed with a VTE and a prescription of a LMWH or DOAC were included. Patients had to be over the age of 65 during VTE diagnosis and continuously enrolled in Medicare parts A, B & D for one year before the VTE diagnosis. Multivariable logistic regression was employed to identify significant factors associated with the use of DOACs versus LMWHs.

RESULTS: The cohort included 4892 LMWH and 5080 DOAC treated patients. Patients with more advanced cancer (OR=0.54, 95% CI=0.41-0.70) were significantly less likely to receive a DOAC as compared to patients in the initial stages. Certain cancer types including breast (OR=1.93, 95% CI=1.65-2.25), colorectal (OR=1.50, 95% CI=1.18-1.90) and prostate (OR=2.12, 95% CI=1.77-2.52) were more likely than lung cancer patients to be prescribed DOACs. Stomach (OR=0.83, 95% CI=0.64-1.07) and pancreatic (OR=0.78, 95%CI=0.66-0.91) cancer patients were less likely to be on DOACs as compared to lung cancer patients. Patients were significantly more likely to be prescribed a DOAC in 2019 (OR=106.39, 95% CI= 42.19-268.28) and the more recent years as compared to 2011. Patients on active cancer treatment were less likely to be on a DOAC (OR=0.74, 95% CI=0.67-0.81).

CONCLUSION: Several sociodemographic and clinical characteristics were associated with the use of DOACs, with year of VTE diagnosis being the strongest predictor. Even without a consistent clinical guideline physicians have been prescribing DOACs to patients.

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