P5586Predictors for not initiating anticoagulant treatment after incident venous thromboembolism: a Danish nationwide study
Authors: Albertsen I , Nielsen P B N , Overvad T F O , Larsen T B L , Soegaard M S 
Published: October 2019

Abstract

Background
Venous thromboembolism (VTE) is common and potentially fatal. Anticoagulation is the treatment cornerstone but up to one-third do not initiate treatment after incident VTE. Identification of patient characteristics associated with non-initiation may enable identification of individuals in need of additional patient education and intensified clinical follow-up.

Purpose
To investigate characteristics associated with not initiating anticoagulation after incident VTE in a Danish nationwide study.

Methods
We linked nationwide Danish health registries to identify consecutive patients with incident VTE between 2000–2016. The outcome was not initiating anticoagulant treatment (warfarin or NOAC) within 30 days after incident VTE diagnosis. Logistic regression was used to identify predictors of treatment non-initiation.

Results
Among 85,046 patients with incident VTE, 41% (n=34,877) patients had not redeemed a prescription of anticoagulation within 30 days after incident VTE. Age<65, female sex, unprovoked VTE, and chronic diseases were associated with non-initiation (Table).
Table 1. Baseline characteristics for incident VTE* patients year 2000–2016 and associated adjusted odds ratios for not initiating anticoagulation† Patients with incident VTE (n=85,046) Adjusted‡ Odds Ratio (95% CI) for not initiating treatment Age, median (IQR), y 65.6 (50.8–77.3) – Age groups, n (%)   0–30 years 4,150 (4.9%) 1.55 (1.45; 1.66)   30–65 years 37,376 (43.9%) 1.24 (1.20; 1.27)   >65 years 43,520 (51.2%) Ref. Females, n (%) 45,119 (53.1%) 1.40 (1.36; 1.44) Unprovoked VTE§, n (%) 53,779 (63.2%) 1.08 (1.06; 1.12) Chronic diseases 10 years within incident VTE   Inflammatory disease¶, n (%) 7,374 (8.7%) 1.07 (1.02; 1.14)   Heart Failure, n (%) 6,242 (7.3%) 1.21 (1.11; 1.32)   Ischemic heart disease, n (%) 11,025 (13.0%) 1.25 (1.19; 1.32)   Chronic obstructive pulmonary disease, n (%) 8,385 (9.9%) 1.02 (0.96; 1.08)   Kidney disease, n (%) 2,626 (3.1%) 1.21 (1.12; 1.32)   Diabetes, n (%) 6,884 (8.1%) 1.13 (1.06; 1.20)   Hypertension, n (%) 233,651 (27.8%) 0.99 (0.94; 1.05) Chronic diseases, n (%)   0 chronic diseases 46,036 (54.1%) Ref.   1–2 chronic diseases 30,462 (35.8%) 1.09 (1.03; 1.15)   >3 chronic diseases 8,548 (10.1%) 1.12 (0.98; 1.28) *Venous thromboembolism. †Defined as not redeeming a prescription on anticoagulant medicine no later than 30 days after an incident VTE diagnosis. ‡Adjusted for age, sex and other baseline characteristics. §Defined as absence of: major surgery, nephrotic syndrome, hormonal replacement therapy, central venous catheter, fracture/trauma and immobilization within 3 months. ¶Combination of inflammatory bowel diseases, lupus erythematosus, psoriasis, rheumatic disorders.

Conclusion
As much as 41% of patients with a first diagnosis of VTE did not initiate anticoagulant treatment within 30 days after diagnosis. In order to optimize compliance, physicians may consider increased focus on identified predictors associated with non-initiation.