{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T20:29:02Z","timestamp":1766089742796,"version":"3.48.0"},"reference-count":0,"publisher":"Canadian Society of Healthcare-Systems Pharmacy","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can J Hosp Pharm"],"abstract":"<jats:p>Background: Unprovoked venous thromboembolism (VTE) has a high risk of recurrence, typically warranting indefinite anticoagulation. Direct-acting oral anticoagulants (DOACs) have several advantages over warfarin and are thus recommended preferentially for long-term use. Until January 2024 in Nova Scotia, DOAC use beyond 6 months was often cost-prohibitive due to limited provincial funding.\nObjective: To evaluate the impact of drug coverage on duration of anticoagulation for unprovoked VTE in Nova Scotia.\nMethods: A retrospective chart review was completed for patients with unprovoked VTE seen in the Halifax Thrombosis Clinic between 2018 and 2020. Patients were grouped by anticoagulant class, type of insurance (private, provincial, or neither), and anticoagulationcontinuation or noncontinuation beyond 6 months. The primary outcome was the difference in anticoagulation use at 6 months according to type of insurance based on \u03c72 testing.\nResults: The chart review identified 1016 patients seen during the study period, of whom 222 were included in the analysis. No significant difference in treatment duration was found among patients with private insurance, those covered under provincial pharmacare, and those with no insurance (mean duration 14.47, 12.39, and 13.89 months, respectively; p = 0.25). Scores for the Charlson comorbidity index and patient age did not significantly affect treatment duration. Patients with private insurance were more likely to receive a prescription for DOACs (p = 0.015 relative to provincial pharmacare, p &lt; 0.001 relative to no insurance).\nConclusions: This study showed no statistically significant difference among types of insurance in terms of duration of anticoagulation after unprovoked VTE. However, patients with private insurance were more likely to use DOACs than warfarin. Since this study was completed, Nova Scotia Pharmacare now covers DOACs, but coverage remains limited in many other provinces. The results of this study may serve as evidence to lobby for extended DOAC funding in other provinces as a way to enhance care.\nKeywords: venous thromboembolism, pharmacare, anticoagulation, health promotion, accessibility\nR\u00c9SUM\u00c9\nContexte : Le risque de r\u00e9cidive de la thromboembolie veineuse (TEV) non provoqu\u00e9e est \u00e9lev\u00e9, ce qui justifie g\u00e9n\u00e9ralement un traitement anticoagulant ind\u00e9fini. Les anticoagulants oraux directs (AOD) ont plusieurs avantages par rapport \u00e0 la warfarine et sont donc recommand\u00e9s de pr\u00e9f\u00e9rence pour un usage \u00e0 long terme. Jusqu\u2019en janvier 2024, en Nouvelle-\u00c9cosse, le co\u00fbt de l\u2019utilisation des AOD au-del\u00e0 de 6 mois \u00e9tait souvent prohibitif en raison du financement provincial limit\u00e9.\nObjectif : \u00c9valuer les cons\u00e9quences de la couverture m\u00e9dicaments sur la dur\u00e9e du traitement anticoagulant pour la TEV non provoqu\u00e9e en Nouvelle-\u00c9cosse.\nM\u00e9thodologie : Une revue r\u00e9trospective des dossiers des patients atteints d\u2019une TEV non provoqu\u00e9e dans l\u2019unit\u00e9 de thrombose de Halifax a \u00e9t\u00e9 r\u00e9alis\u00e9e entre 2018 et 2020. Les patients ont \u00e9t\u00e9 regroup\u00e9s par classe d\u2019anticoagulant administr\u00e9, type d\u2019assurance (priv\u00e9e, provinciale ou aucune) et continuation ou non du traitement apr\u00e8s 6 mois. Le r\u00e9sultat principal a \u00e9t\u00e9 la diff\u00e9rence en mati\u00e8re d\u2019utilisation du traitement anticoagulant \u00e0 6 mois en fonction du type d\u2019assurance, bas\u00e9e sur un test du \u03c72.\nR\u00e9sultats : La revue des dossiers a permis d\u2019identifier 1016 patients vus pendant la p\u00e9riode de l\u2019\u00e9tude, dont 222 ont \u00e9t\u00e9 inclus dans l\u2019analyse. Aucune diff\u00e9rence significative dans la dur\u00e9e du traitement n\u2019a \u00e9t\u00e9 observ\u00e9e parmi les patients ayant une assurance priv\u00e9e, ceux couverts par le programme d\u2019assurance provincial et ceux sans assurance (moyenne de 14,47, 12,39 et 13,89 mois, respectivement; p = 0,25). Les scores de l\u2019indice de comorbidit\u00e9 de Charlson et l\u2019\u00e2ge des patients n\u2019ont pas d\u00e9montr\u00e9 d\u2019effet significatif sur la dur\u00e9e du traitement. Les patients ayant une assurance priv\u00e9e \u00e9taient plus susceptibles de recevoir une ordonnance pour des AOD (p = 0,015 par rapport \u00e0 ceux couverts par l\u2019assurance provinciale; p &lt; 0,001 par rapport aux patients sans assurance).\nConclusions : Cette \u00e9tude n\u2019a montr\u00e9 aucune diff\u00e9rence statistiquement significative entre les types d\u2019assurance en ce qui concerne la dur\u00e9e du traitement anticoagulant pour une TEV non provoqu\u00e9e. Cependant, les patients ayant une assurance priv\u00e9e \u00e9taient plus susceptibles d\u2019utiliser des AOD plut\u00f4t que de la warfarine. Depuis la r\u00e9alisation de cette \u00e9tude, le programme d\u2019assurance de Nouvelle-\u00c9cosse couvre d\u00e9sormais les AOD, mais leur couverture reste limit\u00e9e dans de nombreuses provinces. Les r\u00e9sultats de cette \u00e9tude pourraient servir de preuve afin de faire pression pour \u00e9largir le financement des AOD dans d\u2019autres provinces et am\u00e9liorer les soins.\nMots-cl\u00e9s : thromboembolie veineuse, assurance m\u00e9dicaments, anticoagulation, promotion de la sant\u00e9, accessibilit\u00e9<\/jats:p>","DOI":"10.4212\/cjhp.3688","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T20:24:00Z","timestamp":1766089440000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of Provincial Pharmacare Coverage for Direct Oral Anticoagulants on Long-Term Anticoagulation for Unprovoked Venous Thromboembolism"],"prefix":"10.4212","volume":"78","author":[{"given":"Alex","family":"Robin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Liwski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudeep","family":"Shivakumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allen","family":"Tran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2732","published-online":{"date-parts":[[2025,12,10]]},"container-title":["Canadian Journal of Hospital Pharmacy"],"original-title":[],"link":[{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3688\/5784","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3688\/5785","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3688\/5784","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T20:24:00Z","timestamp":1766089440000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/view\/3688"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":0,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12,10]]}},"URL":"https:\/\/doi.org\/10.4212\/cjhp.3688","relation":{},"ISSN":["1920-2903","0008-4123"],"issn-type":[{"type":"electronic","value":"1920-2903"},{"type":"print","value":"0008-4123"}],"subject":[],"published":{"date-parts":[[2025,12,10]]}}}