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Venous thromboembolism treatment outcomes in cancer patients and effect of third-party payers on anticoagulant choice

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Abstract

Purpose

The purpose of this study is to compare the rates of recurrent VTE among cancer patients treated with parenteral agents to the oral anticoagulants.

Methods

This single-center study was a retrospective chart review of cancer patients with recurrent VTE between January 1, 2009 and December 31, 2014. The primary outcome of the study is the rate of recurrent VTE in patients who received a parenteral anticoagulant (enoxaparin, dalteparin, fondaparinux) versus those who received oral anticoagulants (warfarin and rivaroxaban). Other outcomes investigated include risk factors associated with recurrent VTE events and influence of third-party payer on anticoagulant selection.

Results

Four hundred fifty-seven patients met inclusion criteria (178 in the oral anticoagulant group and 279 in the parenteral anticoagulant group). Patients with Medicare were more likely to have received an oral anticoagulant (P = 0.003) and patients with private insurance were more likely to have received a parenteral anticoagulant (P = 0.004). There were 23 recurrent VTE events, 12 events (6.7 %) in the oral anticoagulant group and 11 events (3.94 %) in the parenteral group (P = 0.182). The only significant risk factor noted to increase risk of recurrent VTE was the presence of an IVC filter (adjusted OR 4.38, 95 % CI 1.67–11.53, P = 0.003).

Conclusions

While there is no statistical difference in VTE events between groups, the oral anticoagulant group numerically had a higher rate. Important associations were found to have an influence on anticoagulant selection and risk of recurrent VTE. These factors must be incorporated into decision making when treating cancer patients with VTE.

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Acknowledgments

This study is supported in part by the Texas Tech Health Sciences Center Clinical Research Institute. We would like to thank Lida Binesheian and Yasmine Alhasan for their assistance in data collection and chart review.

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Authors and Affiliations

  1. 5290 Forest Park Road, Suite 500, Dallas, TX, 75235, USA

    Gary W. Jean

  2. VA North Texas Health Care System, Dallas, TX, USA

    Katherine Kelly

  3. 6201 Harry Hines Boulevard, Dallas, TX, 75390, USA

    Jennie Mathew

  4. 3601 4th Street, STOP 8183, Lubbock, TX, 79430, USA

    Eneko Larumbe

  5. University of Texas Southwestern Medical Center, 6201 Harry Hines Boulevard, Dallas, TX, 75390, USA

    Randall Hughes

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  1. Gary W. Jean
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Correspondence to Gary W. Jean.

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Jean, G.W., Kelly, K., Mathew, J. et al. Venous thromboembolism treatment outcomes in cancer patients and effect of third-party payers on anticoagulant choice. Support Care Cancer 25, 59–66 (2017). https://doi.org/10.1007/s00520-016-3377-x

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