Abstract Rationale Pulmonary embolism (PE) is a common complication of patients with sickle cell disease (SCD). In general populations, the American Society of Hematology (ASH) 2019 Guidelines recommended direct oral anticoagulant (DOAC) over warfarin for treatment of PE, but there are little data and no specific guidelines to guide anticoagulation strategies in patients with SCD. In the context of limited direct evidence, we sought to quantify changes in use of DOACs and warfarin over time relative to ASH guideline publication in patients with PE and SCD. Methods We used the TriNetX database (deidentified electronic health records of over 130 million patients at 103 health care organizations in the United States). We identified adult patients hospitalized with SCD and a new thrombotic PE (based on ICD-10 codes) between October 1, 2015 to July 1, 2024 who were naïve to DOAC and warfarin therapy. We assessed rates of DOAC and warfarin prescriptions within 90 days of PE diagnosis overall and by study quarter, then performed interrupted time series to quantify changes in practice after publication of ASH 2019 guidelines. Results We included 1,587 patients with SCD and new PE. Overall, 671 patients (64%) received DOACs and 91 (9%) patients received warfarin. From quarter 4 2015 through quarter 3 2024, DOAC use increased from 55% to 83% (absolute increase 28%; relative change 50%). Over the same time period, warfarin decreased from 67% to 6% (absolute decrease 61%; relative decrease 92). Prior to ASH 2019 guidelines, DOAC use was increasing by 1 (95% CI 0.2 to 2)% per quarter. After ASH guideline publication, there was no immediate level change in DOAC use (-7%; 95% CI -19 to 4%) or change in the rate of DOAC use per quarter (-0.5%; 95% CI -2 to 0.7%); Figure 1. Prior to ASH guideline publication, warfarin was decreasing by 1 (95% CI -1.8 to -0.7)% per quarter. There was no immediate level change in warfarin use (-1.0%, 95% CI = -6 to 8%, p = 0.8), but the rate of warfarin use per quarter increased slightly (1%; 95% CI 0.4 to 1.8%; p = 0.001) after guideline publication; Figure 1. Conclusions Amongst patients with SCD and first-time PE from 2016 to 2024, DOAC use increased steadily over time irrespective of 2019 ASH guidelines. In the setting of limited comparative effectiveness data in patients with SCD, future studies should compare outcomes between DOAC vs warfarin use in this population. This abstract is funded by: None
Flores et al. (Fri,) studied this question.