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Updated: Jul 30, 2025
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Published on: June 2, 2015
Venous thromboembolism recurrence among one-and-done direct oral anticoagulant users: a retrospective longitudinal
Mark Alberts1, Maryia Zhdanava2, Dominic Pilon3
1Hartford Hospital, Hartford, CT, USA.
Insights
Discontinuing direct oral anticoagulants (DOACs) after the first fill significantly increases venous thromboembolism (VTE) recurrence risk. Encouraging early DOAC access is crucial for preventing VTE recurrence.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Pharmacology
Background:
- Direct oral anticoagulants (DOACs) are guideline-recommended treatments for venous thromboembolism (VTE) in the United States.
- A significant proportion of patients discontinue DOAC therapy after initial prescription.
Purpose of the Study:
- To compare the risk of VTE recurrence between patients who discontinued DOACs after the first fill ('one-and-done') and those who continued therapy ('continuers').
Main Methods:
- Analysis of open-source US insurance claims data from April 2017 to October 2020.
- Classification of adult VTE patients into 'one-and-done' (one DOAC claim in 45 days) or 'continuers' cohorts.
- Use of inverse probability of treatment weighting and Cox proportional hazard models to compare VTE recurrence risk.
Main Results:
- 27% of patients initiating DOACs were classified as 'one-and-done'.
- After weighting, cohorts comprised over 117,000 patients each, with a mean follow-up of 15 months.
- The 'one-and-done' cohort had a 19% higher risk of VTE recurrence compared to 'continuers' (HR 1.19 [1.13, 1.25]).
Conclusions:
- Discontinuation of DOAC therapy after the first fill is associated with a significantly higher risk of VTE recurrence.
- Encouraging early and consistent access to DOACs is recommended to mitigate VTE recurrence.
- This finding highlights the importance of medication adherence in managing VTE.
Background:
Direct oral anticoagulants (DOACs) are the American Society of Hematology guideline-recommended treatment for venous thromboembolism (VTE) in the United States (US).
Aim:
To compare risk of VTE recurrence between patients who, following the first fill, discontinued ("one-and-done") versus those who continued ("continuers") DOACs.
Method:
Open source US insurance claims data (04/1/2017 to 10/31/2020) were used to select adult patients with VTE initiated on DOACs (index date). Patients with only one DOAC claim during the 45-day landmark period (starting on the index date) were classified as one-and-done and the remaining as continuers. Inverse probability of treatment weighting was used to reweight baseline characteristics between cohorts. VTE recurrence based on the first post-index deep vein thrombosis or pulmonary embolism event was compared using weighted Kaplan-Meier and Cox proportional hazard models from landmark period end to clinical activity or data end.
Results:
27% of patients initiating DOACs were classified as one-and-done. After weighting, 117,186 and 116,587 patients were included in the one-and-done and continuer cohorts, respectively (mean age 60 years; 53% female; mean follow-up 15 months). After 12 months of follow-up, the probability of VTE recurrence was 3.99% and 3.36% in the one-and-done and continuer cohorts; the risk of recurrence was 19% higher in the one-and-done cohort (hazard ratio [95% confidence interval] = 1.19 [1.13, 1.25]).
Conclusion:
Substantial proportion of patients discontinued DOAC therapy after the first fill, which was associated with significantly higher risk of VTE recurrence. Early access to DOACs should be encouraged to reduce the risk of VTE recurrence.
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