Warfarin Time in Therapeutic INR Range and Direct Oral Anticoagulant Adherence for Venous Thromboembolism Across the Spectrum of Weight and Body Mass Index: Findings from Veterans Health Administration
The evidence of direct oral anticoagulants (DOACs) usage for venous thromboembolism (VTE) in patients at extremes of body weight or mass index is limited. In such situations, warfarin may be more frequently used. We investigated warfarin time in the therapeutic international normalized ratio range (...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-01-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/10760296231152474 |
| _version_ | 1828048499748372480 |
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| author | Natasha Din MBBS MAS Jun Fan MS Susan Schmitt PhD Jennifer D. Guo PhD Patrick Hlavacek MPH Krishna Pundi MD Cristina Russ MD Birol Emir PhD Mintu P. Turakhia MD MAS FAHA Alexander C. Perino MD |
| author_facet | Natasha Din MBBS MAS Jun Fan MS Susan Schmitt PhD Jennifer D. Guo PhD Patrick Hlavacek MPH Krishna Pundi MD Cristina Russ MD Birol Emir PhD Mintu P. Turakhia MD MAS FAHA Alexander C. Perino MD |
| author_sort | Natasha Din MBBS MAS |
| collection | DOAJ |
| description | The evidence of direct oral anticoagulants (DOACs) usage for venous thromboembolism (VTE) in patients at extremes of body weight or mass index is limited. In such situations, warfarin may be more frequently used. We investigated warfarin time in the therapeutic international normalized ratio range (TTR) and DOAC adherence based on the calculated proportion of days covered (PDC) by pill coverage from a DOAC prescription in patients with VTE across all body sizes. Using data from the Veterans Health Administration (VA), we identified first-time patients with VTE between 2013 and 2018 treated with warfarin or DOACs. We analyzed 28,245 patients with warfarin TTR (N = 10,167) or DOAC PDC(N = 18,078). For warfarin-treated patients after index VTE, mean TTR was lower over shorter treatment durations (TTR 30 vs TTR 180 [mean ± SD]: 43.8% ± 33.5% vs 58.8% ± 23.5%). Mean TTR over 180 days after VTE was lowest for patients <60 kg (TTR 180 [mean ± SD]: <60kg: 49.3% ± 24.2% vs ≥60 to <100 kg: 57.8% ± 23.4%; P < .0001). For DOAC-treated patients over 180 days after index VTE, mean PDC was lowest for patients <60 kg (PDC 180 [mean ± SD]: < 60kg: 76.9% ± 33.2% vs ≥ 60 to <100 kg: 83.6% ± 27.7%; P < .0001). Most DOAC-treated patients attained sufficient adherence across the body size spectrum while warfarin-treated patients <60kg were at risk for low TTR. |
| first_indexed | 2024-04-10T18:58:25Z |
| format | Article |
| id | doaj.art-e19372c771f14857a0d501e2db7c578d |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-04-10T18:58:25Z |
| publishDate | 2023-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-e19372c771f14857a0d501e2db7c578d2023-01-31T17:03:28ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232023-01-012910.1177/10760296231152474Warfarin Time in Therapeutic INR Range and Direct Oral Anticoagulant Adherence for Venous Thromboembolism Across the Spectrum of Weight and Body Mass Index: Findings from Veterans Health AdministrationNatasha Din MBBS MAS0Jun Fan MS1Susan Schmitt PhD2Jennifer D. Guo PhD3Patrick Hlavacek MPH4Krishna Pundi MD5Cristina Russ MD6Birol Emir PhD7Mintu P. Turakhia MD MAS FAHA8Alexander C. Perino MD9 Center for Digital Health, , Stanford, CA, USA Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA Bristol Myers Squibb, Lawrenceville, NJ, USA former employee at the time the study was conducted Pfizer, New York, NY, USA Department of Medicine, , Stanford, CA, USA Pfizer, New York, NY, USA Pfizer, New York, NY, USA Department of Medicine, , Stanford, CA, USA Department of Medicine, , Stanford, CA, USAThe evidence of direct oral anticoagulants (DOACs) usage for venous thromboembolism (VTE) in patients at extremes of body weight or mass index is limited. In such situations, warfarin may be more frequently used. We investigated warfarin time in the therapeutic international normalized ratio range (TTR) and DOAC adherence based on the calculated proportion of days covered (PDC) by pill coverage from a DOAC prescription in patients with VTE across all body sizes. Using data from the Veterans Health Administration (VA), we identified first-time patients with VTE between 2013 and 2018 treated with warfarin or DOACs. We analyzed 28,245 patients with warfarin TTR (N = 10,167) or DOAC PDC(N = 18,078). For warfarin-treated patients after index VTE, mean TTR was lower over shorter treatment durations (TTR 30 vs TTR 180 [mean ± SD]: 43.8% ± 33.5% vs 58.8% ± 23.5%). Mean TTR over 180 days after VTE was lowest for patients <60 kg (TTR 180 [mean ± SD]: <60kg: 49.3% ± 24.2% vs ≥60 to <100 kg: 57.8% ± 23.4%; P < .0001). For DOAC-treated patients over 180 days after index VTE, mean PDC was lowest for patients <60 kg (PDC 180 [mean ± SD]: < 60kg: 76.9% ± 33.2% vs ≥ 60 to <100 kg: 83.6% ± 27.7%; P < .0001). Most DOAC-treated patients attained sufficient adherence across the body size spectrum while warfarin-treated patients <60kg were at risk for low TTR.https://doi.org/10.1177/10760296231152474 |
| spellingShingle | Natasha Din MBBS MAS Jun Fan MS Susan Schmitt PhD Jennifer D. Guo PhD Patrick Hlavacek MPH Krishna Pundi MD Cristina Russ MD Birol Emir PhD Mintu P. Turakhia MD MAS FAHA Alexander C. Perino MD Warfarin Time in Therapeutic INR Range and Direct Oral Anticoagulant Adherence for Venous Thromboembolism Across the Spectrum of Weight and Body Mass Index: Findings from Veterans Health Administration Clinical and Applied Thrombosis/Hemostasis |
| title | Warfarin Time in Therapeutic INR Range and Direct Oral Anticoagulant Adherence for Venous Thromboembolism Across the Spectrum of Weight and Body Mass Index: Findings from Veterans Health Administration |
| title_full | Warfarin Time in Therapeutic INR Range and Direct Oral Anticoagulant Adherence for Venous Thromboembolism Across the Spectrum of Weight and Body Mass Index: Findings from Veterans Health Administration |
| title_fullStr | Warfarin Time in Therapeutic INR Range and Direct Oral Anticoagulant Adherence for Venous Thromboembolism Across the Spectrum of Weight and Body Mass Index: Findings from Veterans Health Administration |
| title_full_unstemmed | Warfarin Time in Therapeutic INR Range and Direct Oral Anticoagulant Adherence for Venous Thromboembolism Across the Spectrum of Weight and Body Mass Index: Findings from Veterans Health Administration |
| title_short | Warfarin Time in Therapeutic INR Range and Direct Oral Anticoagulant Adherence for Venous Thromboembolism Across the Spectrum of Weight and Body Mass Index: Findings from Veterans Health Administration |
| title_sort | warfarin time in therapeutic inr range and direct oral anticoagulant adherence for venous thromboembolism across the spectrum of weight and body mass index findings from veterans health administration |
| url | https://doi.org/10.1177/10760296231152474 |
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