OBJECTIVES: To assess the management of anti-thrombotic therapy among patients with provoked or unprovoked venous thromboembolism (VTE) in a real world setting.

METHODS: We identified primary VTE events occurring between 2007 and 2013 using computerized databases of a 2-million member health plan. Length of treatment with anti-coagulant therapy (low molecular weight heparins (LMWH), warfarin, and novel oral anticoagulants) and type of initial medication were compared between unprovoked and provoked (active-cancer-associated and other provoked) VTE.

RESULTS: Among the study population (n=8,947; mean age=59y, SD=18y), 69.5% initiated anti-coagulant therapy. Median treatment duration with anticoagulation therapy was longer for patients with pulmonary embolism (PE) (415 days) compared with deep vein thrombosis (DVT) patients (206 days).

Cancer-associated provoked patients were significantly (P<0.01) more likely to initiate anticoagulation therapy with LMWH (68% for PE and 70% for DVT) compared with patients with other provoked or unprovoked VTE (30% and 47%, respectively). Duration with LMWH among these patients was also significantly (P<0.01) longer (median=129 days) compared to those with other provoked (31 days) and unprovoked VTE (27 days).

CONCLUSIONS: A substantial proportion of VTE patients are not treated with anticoagulation therapy within 3 months from event. LMWH are more extensively used in cancer-associated VTE patients. Further study is needed to determine the reasons for this gap in provision of care and whether adherence to therapy improves once NOACs are introduced as first-line therapy.