Practice patterns of DOAC high-intensity period following parenteral lead-in treatment for venous thromboembolism

In the acute care setting, consensus is lacking on whether patients initially treated with parenteral anticoagulation for venous thromboembolism (VTE) should complete the full high-intensity period (HIP) of apixaban or rivaroxaban. This study examines HIP prescribing patterns following parenteral anticoagulation and assesses the influence of patient, provider, and facility characteristics. Patients initiating rivaroxaban or apixaban for VTE after parenteral anticoagulation were identified from the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) database between November 2015 and March 2024. Those with an indeterminate duration of parenteral treatment were excluded. Patients were categorized into full HIP and shortened HIP cohorts based on DOAC dose and duration. Demographics and comorbidities were compared using Student's t-test and Chi-squared or Fisher's exact tests. Variables with p < 0.3 were included in a logistic regression model, with stepwise selection at a 0.1 significance threshold. Among 816 patients, 687 (84.2%) received the full HIP, while 129 (15.8%) had a shortened HIP. Patients with private insurance (OR 0.3 [0.11-0.82], p = 0.02) or Medicare (OR 0.31 [0.11-0.92], p = 0.04) were less likely to receive a shortened HIP than Medicaid patients. Higher HAS-BLED scores were associated with increased odds of receiving a shortened HIP (OR 1.32 [1.1-1.59], p = 0.003). Provider type did not significantly impact HIP prescribing patterns. Despite prior parenteral anticoagulation, most patients completed the full DOAC HIP. Further research is needed to assess how patient, provider, and facility factors influence decision-making and to evaluate the impact of these decisions on clinical outcomes.