Abstract 4: Disparities in the Use of Direct Oral Anticoagulant Treatment of Venous Thromboembolism in the United States, 2010-2016

Abstract

Background: Venous thromboembolism (VTE) occurs in approximately 100 persons per 100,000 each year in the United States, and for decades warfarin had been the mainstay of therapy. However, beginning in 2012 direct oral anticoagulants (DOAC) were approved for treatment and prevention of VTE, and are now recommended as first-line therapy. We assessed the factors associated with direct oral anticoagulant use among commercially-insured VTE patients. Methods: We performed a retrospective cohort analysis of adult patients with an incident diagnosis of VTE between 01/01/2010 and 12/01/2016 using OptumInsight’s Clinformatics Data Mart, a large US health care claims database. We identified the first filled anticoagulant prescription within 30 days of discharge, as well as baseline demographic and socioeconomic characteristics for all VTE patients with available prescription data. We then performed a multivariate logistic regression, adjusting for age, sex, race/ethnicity, region of residence, household net worth, prescribing provider specialty, and clinical covariates to identify factors associated with the use of direct oral anticoagulants. Results: There were 12,390 patients included in the analysis. In adjusted multivariate analyses, there was no difference in the use of DOAC among men and women (OR 0.99, 95% CI 0.91 - 1.08, p=0.80). Black patients were less likely to receive a DOAC compared to white patients (OR 0.86, 95% CI 0.76 - 0.98, p=0.020). There were no differences in the utilization among Asian patients (OR 1.21, 95% CI 0.83 - 1.75, p=0.324) or Hispanic patients (OR 1.04, 95% CI 0.88 - 1.23, p=0.66) as compared to white patients. Conclusion: Although DOAC adoption has increased steadily, among a commercially-insured population, black race was independently associated with the use of warfarin as compared to DOAC for incident VTE despite controlling for other socioeconomic factors. This finding was not present among Asian or Hispanic patients. This suggests the possibility of a racial disparity in access to this new pharmacotherapy.