Adherence to guidelines for oral anticoagulation after venous thrombosis and pulmonary embolism

OBJECTIVE: Guidelines for oral anticoagulation after deep venous thrombosis (DVT) or pulmonary embolism (PE) have recommended that patients be anticoa gulated for at least 3 months after hospital discharge. We sought to determ ine whether this recommendation was being followed and what patient charact eristics predict a shorter than recommended duration of therapy. DESIGN: Retrospective cohort study using linked health care claims data. SETTING: Routine clinical practice. PATIENTS: Five hundred seventy-three members of New Jersey's Medicaid or Ph armacy Assistance for the Aged and Disabled programs aged 65 years and olde r who were hospitalized for DVT or PE between January 1, 1991 and June 30, 1994. RESULTS: Of the 573 patients, 129 (23%) filled prescriptions covering less than 90 days of oral anticoagulant therapy. In multivariate models, African -American race was associated with an increased risk of a shorter than reco mmended duration of therapy (odds ratio [OR]. 1.87: 95% confidence interval [CI], 1.14 to 3.08), but age and gender were not. Patients who used antico agulants in the year prior to admission were less likely to have a short du ration of therapy (OR, 0.30: 95% CI, 0.12 to 0.78), than were patients with PE (OR, 0.58; 95% CI, 0.38 to 0.88). CONCLUSIONS: Nearly a quarter of those anticoagulated following DVT or PE r eceived therapy for less than the recommended length of time after hospital discharge, with African Americans more likely to have a shorter than recom mended course of treatment. Further research is needed to evaluate the caus es of shorter than recommended duration of therapy and racial disparities i n anticoagulant use.