Abstract 3367: Treatment patterns in patients with cancer-associated venous thromboembolism in the US: A real world retrospective database analysis

Abstract

Abstract Background: Cancer patients have higher risk of venous thromboembolism (VTE) due to the cancer-induced hypercoagulable state or activation of the coagulation cascade by chemotherapy. The 2018 National Comprehensive Cancer Network guidelines recommend low molecular weight heparin (LMWH) to treat cancer-associated VTE and direct oral anticoagulants (DOACs) in some circumstances. This study aimed to understand VTE treatment patterns in a cancer-associated VTE population during hospitalization and post-discharge. Methods: Patients with cancer-associated VTE and their respective treatments were identified in IQVIA’s hospital Charge Data Master database from 7/1/15 to 4/30/18. Patients were followed for 1 month after VTE hospitalization. Post-discharge therapy was obtained from outpatient medical and pharmacy claims data. Results: A total of 5,920 cancer patients hospitalized for VTE (54% female; mean age 65.9 [SD=13.0] years) were included. Lung (20%) and breast (13%) cancers were the most common cancer types. Average length of stay was 5.3 days (SD=4.1). 5,366 (91%) patients were treated during the hospital stay; LMWH (51%), DOACs (15%) and warfarin (12%) were the most common inpatient treatments. Within 30 days after discharge, the most common treatments were DOACs (26%) and LMWH (16%); 2,858 (48%) had no observed treatment in the outpatient setting. After discharge, 1,272 (21%) patients remained on the same therapy and 1,436 (24%) switched to a new treatment. Among those patients initiating DOACs (N=865) during hospitalization, 46% remained on DOACs after discharge. Conclusions: In US hospital and outpatient settings, this real world study showed that LMWH treatment and treatment with DOACs were the most common initial inpatient therapies for cancer-associated VTE. DOACs were the most common post discharge treatment. Further investigation of patients without continued treatment within 30 days of discharge is warranted. Distribution of post-discharge VTE therapy by initial VTE observed during index hospitalizationInitial VTE therapy during hospitalization(n=5,920)Post-Discharge VTE TherapyLMWH(n=918)Heparin(n=12)Warfarin(n=560)DOAC(n=1,561)Thrombolytic Agent (n=11)No post-discharge VTE treatment(n=2,858)LMWH n=3,040; 51.4%648 (21.3%)6 (0.2%)213 (7.0%)678 (22.3%)6 (0.2%)1,489 (49.0%)Heparin n=566; 9.6%48 (8.5%)2 (0.4%)34 (6.0%)166 (29.3%)1 (0.2%)315 (55.7%)Warfarin n=685; 11.6%80 (11.7%)2 (0.3%)242 (35.3%)86 (12.6%)2 (0.3%)273 (39.9%)DOAC n=865; 14.6%25 (2.9%)0 (0.0%)13 (1.5%)400 (46.2%)1 (0.1%)426 (49.2%)Thrombolytic agent n=210; 3.5%36 (17.1%)1 (0.5%)13 (6.2%)50 (23.8%)1 (0.5%)109 (51.9%)No initial VTE treatment n=554; 9.4%81 (14.6%)1 (0.2%)45 (8.1%)181 (32.7%)0 (0.0%)246 (44.4%)* Patients with no treatment within 30 days after hospital discharge were censored at 30-days post-dishcarge Citation Format: Jennifer D. Guo, Patrick Hlavacek, Tayla Poretta, Gail Wygant, Daniel C. Lane, Magdaliz Gorritz, Xin Wang, Chi-Chang Chen, Xianying Pan, Lisa Rosenblatt. Treatment patterns in patients with cancer-associated venous thromboembolism in the US: A real world retrospective database analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3367.