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Clinical and sociodemographic factors associated with anticoagulant use for cancer associated venous thromboembolism

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Abstract

Cancer associated thrombosis (CAT) is a leading cause of death among patients with cancer. It is not clear if non-clinical factors are associated with anticoagulation receipt. We conducted a retrospective cohort study of Optum’s de-identified Clinformatics® Database of adults with cancer diagnosed between 2009 and 2016 who developed CAT, treated with an outpatient anticoagulant (warfarin, low molecular weight heparin (LMWH), or a direct oral anticoagulant (DOAC)). Of 12,622 patients, three months after an episode of CAT, 1,485 (12%) were on LMWH, 1,546 (12%) on DOACs, and 9,591 (76%) were on warfarin. When controlling for other factors, anticoagulant use was significantly associated with socioeconomic factors, region, co-morbidities, type of thrombosis, and cancer subtype. Patients with a bachelor’s degree or greater level of education were less likely to receive warfarin (OR: 0.77; 95% CI: [0.59, 0.99]; p < 0.046) or DOACs (OR: 0.67; 95% CI: [0.55, 0.82]; p < 0.001) compared to LMWH. Patients with higher income levels were more likely to receive LMWH or DOACs compared to warfarin, while patients across all income levels were equally likely to receive LMWH or DOACs. Non-clinical factors including income, education, and region, are associated with anticoagulation receipt three months after an episode of CAT. Sociodemographic factors may result in some patients receiving suboptimal care and contribute to non-guideline concordant care for CAT.

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Authors and Affiliations

  1. Department of Medicine, Division of Hematology/Oncology, University of Michigan, C366 Med Inn Building, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    Jordan K. Schaefer, Jennifer J. Griggs & Suman L. Sood

  2. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

    Mengbing Li & Zhenke Wu

  3. Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, USA

    Zhenke Wu

  4. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    Zhenke Wu

  5. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

    Tanima Basu, Geoffrey D. Barnes & Jennifer J. Griggs

  6. Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA

    Geoffrey D. Barnes

  7. Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada

    Marc Carrier

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  1. Jordan K. Schaefer
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Contributions

JKS, ZW, SLS, and JJG designed the study. JKS, ML, ZW, SLS, JJG, and TB collected and analyzed the data. JKS drafted the manuscript. All authors reviewed and approved the final version.

Corresponding author

Correspondence to Jordan K. Schaefer.

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Conflict of interest

Geoffrey Barnes reports honoraria from Pfizer/BMS, Janssen, Portola, and AMAG Pharmaceuticals, research funding from Blue Cross Blue Shield of Michigan, BMS, Pfizer, and NHLBI. Marc Carrier reports research funding from BMS, Pfizer, Leo Pharma and honoraria from Bayer, BMS, Pfizer, Leo Pharma, Sanofi, and Servier. Suman Sood reports consulting for Bayer. Mengbing Li reports research funding from the Michigan Institute for Data Science (MIDAS). Zhenke Wu reports research funding from the National Cancer Institute of the NIH under award number P30CA046592 through the Cancer Center Support Grant (CCSG), Development Funds from the Rogel Cancer Center, and an investigator award from Michigan Precision Health Initiative, and funds from Michigan Institute for Data Science (MIDAS). All other authors have no conflict of interests to declare.

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Schaefer, J.K., Li, M., Wu, Z. et al. Clinical and sociodemographic factors associated with anticoagulant use for cancer associated venous thromboembolism. J Thromb Thrombolysis 52, 214–223 (2021). https://doi.org/10.1007/s11239-021-02392-9

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  • DOI: https://doi.org/10.1007/s11239-021-02392-9

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