{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:31:17Z","timestamp":1792812677220,"version":"4.5.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To evaluate prescribing patterns of OACs for patients with VTE and identify clinical events that precede treatment changes.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study used data from a public (Medicare fee-for-service) and a commercial (IBM MarketScan) health insurance database on 298\u202f609 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.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Warfarin and the DOACs rivaroxaban, apixaban, dabigatran, and edoxaban.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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 \u226530 days), and treatment switches were assessed. Clinical events in the 30 days preceding treatment modifications were identified.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 203\u202f378 individuals with Medicare (mean [SD] age, 76.9 [7.6] years; 122\u202f554 women [60.3%]) and 95\u202f231 with commercial insurance (mean [SD] age, 57.6 [15.8] years; 47\u202f139 women [49.5%]) were included (N\u2009=\u2009298\u202f609). Warfarin was the most frequent OAC prescribed (163\u202f044 [54.6%]), followed by rivaroxaban (66\u202f882 [22.3%]) and apixaban (65\u202f997 [22.1%]). The proportion of patients initiating DOACs increased from 0% in 2010 to 86.8% (22\u202f420 of 25\u202f817) 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\u202f561 [11.9%]) or apixaban (16\u202f294 [5.5%]) than rivaroxaban (10\u202f136 [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\u202f011 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\u202f011]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.4059","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T15:10:29Z","timestamp":1679497829000},"page":"e234059","source":"Crossref","is-referenced-by-count":58,"title":["Trends in the Use of Oral Anticoagulants for Adults With Venous Thromboembolism in the US, 2010-2020"],"prefix":"10.1001","volume":"6","author":[{"given":"Geetha S.","family":"Iyer","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Epidemiology, Harvard T.H. 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