Trends in the Use of Oral Anticoagulants for Adults With Venous Thromboembolism in the US, 2010-2020.

Importance: The introduction of direct oral anticoagulants (DOACs) has transformed the treatment of venous thromboembolism (VTE). Large health care databases offer valuable insight into how oral anticoagulants (OACs) are used in clinical practice and may aid in understanding reasons for changes in therapy. Objectives: To evaluate prescribing patterns of OACs for patients with VTE and identify clinical events that precede treatment changes. Design, Setting, and Participants: This retrospective cohort study used data from a public (Medicare fee-for-service) and a commercial (IBM MarketScan) health insurance database on 298 609 patients initiating OACs within 90 days of index VTE hospitalization from January 1, 2009, to December 31, 2020. Statistical analysis was conducted from April to August 2022. Exposures: Warfarin and the DOACs rivaroxaban, apixaban, dabigatran, and edoxaban. Main Outcomes and Measures: Characteristics of patients initiating different OACs, along with trends over time of patients initiating OACs, were compared. Time receiving continuous anticoagulant therapy, patterns of anticoagulant discontinuation (treatment gap of ≥30 days), and treatment switches were assessed. Clinical events in the 30 days preceding treatment modifications were identified. Results: A total of 203 378 individuals with Medicare (mean [SD] age, 76.9 [7.6] years; 122 554 women [60.3%]) and 95 231 with commercial insurance (mean [SD] age, 57.6 [15.8] years; 47 139 women [49.5%]) were included (N = 298 609). Warfarin was the most frequent OAC prescribed (163 044 [54.6%]), followed by rivaroxaban (66 882 [22.3%]) and apixaban (65 997 [22.1%]). The proportion of patients initiating DOACs increased from 0% in 2010 to 86.8% (22 420 of 25 817) in 2019 for patients with Medicare and 92.1% (4012 of 4357) in 2020 for commercially insured patients. Patients with chronic kidney disease were more likely to initiate warfarin (35 561 [11.9%]) or apixaban (16 294 [5.5%]) than rivaroxaban (10 136 [3.4%]), and those with a history of bleeding were more likely to initiate apixaban (5424 [1.8%]) than rivaroxaban (3007 [1.0%]). Overall, patients received persistent OAC treatment for approximately 6 months (Medicare: median, 175 days [IQR, 76-327 days]; commercial insurance: median, 168 days [IQR, 83-279 days]). A total of 33 011 patients (11.1%) switched anticoagulant therapy within a year. Switching to another anticoagulant was preceded most frequently by codes for a VTE diagnostic procedure (27.2% of all switchers [8983 of 33 011]). Conclusions and Relevance: This cohort study using data from 2 US health insurance databases suggests that most patients with VTE continued oral anticoagulant treatment for approximately 6 months. Clinical reasons for modifying anticoagulant therapy were identified in one-third of patients. Identifying reasons for treatment modification is crucial for generating valid evidence on drug safety and effectiveness.

Impact of smoking status on health-related quality of life (HRQoL) in cancer survivors.

Introduction: The Health-Related Quality of Life (HRQoL) often declines among cancer survivors due to many factors. Some cancer patients who smoke before the cancer diagnosis continue this harmful habit, potentially contributing to a more significant decline in their HRQoL. Therefore, this study investigates the association between smoking status and HRQoL in cancer survivors. Methods: We conducted a cross-sectional study utilizing self-reported cancer history from 39,578 participants of the Behavioral Risk Factor Surveillance System (BRFSS) database, leveraging 2016 and 2020 year questionaries. A multidimensional composite outcome was created to assess HRQoL, integrating four distinct dimensions - general health, mental health, physical health, and activity limitations. After accounting for the complex survey design, logistic regression models were used to analyze the association between smoking status and poor HRQoL, adjusting for demographic, socioeconomic, and health-related confounders. Results: Our study found that, after adjusting for potential confounders, current smokers exhibited a significantly poorer HRQoL than never smokers (OR 1.65, 95%CI 1.40-1.93). Furthermore, former smokers showed a poorer HRQoL than never smokers; however, this association was not as strong as current smokers (OR 1.22, 95%CI 1.09-1.38). Conclusion: Our findings highlight the adverse association of smoking with poor HRQoL in cancer survivors, underscoring the importance of healthcare professionals prioritizing smoking cessation and providing tailored interventions to support this goal.