Association between insurance status, anticoagulation quality, and clinical outcomes in patients with acute venous thromboembolism.


INTRODUCTION:A higher level of health insurance coverage may be related to better quality of care and outcomes. Whether insurance status is associated with anticoagulation quality and clinical outcomes in patients with venous thromboembolism (VTE) is unknown. METHODS:We studied 819 elderly patients treated with vitamin K antagonists for VTE in a Swiss prospective multicenter cohort (09/2009-12/2013). The study outcomes were the anticoagulation quality, defined as the time spent in the therapeutic INR range, and clinical events, i.e. the time to a first VTE recurrence, major bleeding, and mortality. We assessed the association between insurance status (private vs. general), anticoagulation quality, and clinical outcomes using regression models, adjusting for potential confounders. RESULTS:Although the unadjusted mean percentage of time spent in the therapeutic INR range (2.0-3.0) was slightly higher in patients with private vs. general insurance (65% vs. 61%; p = 0.030), the adjusted difference was not statistically significant (1.53%, 95% CI -1.97 to 5.04). Patients with private insurance had a lower 36-month cumulative incidence of major bleeding (9.7% vs. 15.7%; p = 0.018). After adjustment, privately insured patients had a lower risk of major bleeding compared to patients with general insurance (sub-hazard ratio 0.57, 95% CI 0.32 to 0.98). Insurance status was not associated with recurrent VTE or mortality. CONCLUSION:Privately insured patients spent somewhat more time in therapeutic INR range and had a lower rate of major bleeding than generally insured patients. Basic (general) health insurance may be a marker of lower anticoagulation quality and higher risk of major bleeding.


Thromb Res


Thrombosis research


Zumbrunn B,Stalder O,Méan M,Limacher A,Tritschler T,Rodondi N,Aujesky D




Has Abstract


2019-01-01 00:00:00












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    authors: Gorski MM,de Haan HG,Mancini I,Lotta LA,Bucciarelli P,Passamonti SM,Cairo A,Pappalardo E,van Hylckama Vlieg A,Martinelli I,Rosendaal FR,Peyvandi F

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    journal_title:Thrombosis research

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    authors: Ramacciotti E,Wolosker N,Puech-Leao P,Zeratti EA,Gusson PR,del Giglio A,Franco RF

    更新日期:2003-02-15 00:00:00

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    journal_title:Thrombosis research

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    journal_title:Thrombosis research

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    authors: Assanelli D,Grassi M,Bonanome A,Salvadori G,Bonetti P,Boldini A,Archetti S,Ruggeri G,Pezzini A,Pagnan A

    更新日期:2002-01-15 00:00:00

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    authors: Lian EC,Mui PT,Siddiqui FA,Chiu LL

    更新日期:1984-01-01 00:00:00

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    journal_title:Thrombosis research

    pub_type: 杂志文章


    authors: Rabaud M,Lefebvre F,Piquet Y,Belloc F,Chevaleyre J,Roudaut MF,Bricaud H

    更新日期:1986-07-15 00:00:00

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    journal_title:Thrombosis research

    pub_type: 杂志文章


    authors: Takada Y,Takada A

    更新日期:1991-07-01 00:00:00

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    journal_title:Thrombosis research

    pub_type: 杂志文章,meta分析


    authors: Liu M,Yuan X,Qiu X,Shan X,Lin D,Zhu L

    更新日期:2015-01-01 00:00:00

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    journal_title:Thrombosis research

    pub_type: 杂志文章,随机对照试验


    authors: Dahm AE,Eilertsen AL,Goeman J,Olstad OK,Ovstebø R,Kierulf P,Mowinckel MC,Skretting G,Sandset PM

    更新日期:2012-07-01 00:00:00

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    journal_title:Thrombosis research

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    authors: Michelsen AE,Notø AT,Brodin E,Mathiesen EB,Brosstad F,Hansen JB

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    authors: Baños G,de la Peña A,Izaguirre R

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    authors: Nash GB

    更新日期:1994-01-01 00:00:00

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    authors: Hum OS,Ghista DN,Brash JL

    更新日期:1985-04-15 00:00:00

  • The anti-thrombotic effect of hydrogen sulfide is partly mediated by an upregulation of nitric oxide synthases.

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    authors: Kram L,Grambow E,Mueller-Graf F,Sorg H,Vollmar B

    更新日期:2013-08-01 00:00:00

  • Anticoagulant and antithrombotic actions of a semisynthetic beta-1,3-glucan sulfate.

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    authors: Alban S,Jeske W,Welzel D,Franz G,Fareed J

    更新日期:1995-05-01 00:00:00

  • The use of aspirin for primary and secondary prevention in venous thromboembolism and other cardiovascular disorders.

    abstract::Cardiovascular disease (CVD) includes a number of conditions such as myocardial infarction, coronary heart disease, stroke, and venous thromboembolism. CVD is a leading health problem worldwide and a major cause of mortality, morbidity, and disability; it is also associated with high healthcare costs. The incidence of...

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    pub_type: 杂志文章,评审


    authors: Cohen AT,Imfeld S,Markham J,Granziera S

    更新日期:2015-02-01 00:00:00

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    journal_title:Thrombosis research

    pub_type: 杂志文章


    authors: Maruyama I,Soejima Y,Osame M,Ito T,Ogawa K,Yamamoto S,Dittman WA,Saito H

    更新日期:1991-02-01 00:00:00

  • Effects of desmopressin and dextran on coagulation and fibrinolysis in healthy volunteers.

    abstract::The effects of desmopressin and dextran on haemostasis and fibrinolysis were studied in four healthy volunteers. Both drugs were compared to placebo, each volunteer being subject to four experiments. Dextran 70 (30 g i.v.) moderately decreased VIII:C and vWF:Ag and slightly increased antithrombin III, also when haemod...

    journal_title:Thrombosis research

    pub_type: 临床试验,杂志文章


    authors: Flordal PA,Svensson J,Ljungström KG

    更新日期:1991-06-01 00:00:00

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    journal_title:Thrombosis research

    pub_type: 杂志文章


    authors: Nicolini FA,Mehta JL

    更新日期:1990-12-01 00:00:00

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    pub_type: 杂志文章


    authors: Wu TH,Chen HH,Lee TK

    更新日期:2000-02-01 00:00:00

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    pub_type: 杂志文章,评审


    authors: Cerletti C,Tamburrelli C,Izzi B,Gianfagna F,de Gaetano G

    更新日期:2012-03-01 00:00:00

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    journal_title:Thrombosis research

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    authors: Knoll B,Hach-Wunderle V,Rieger S,Häring D,Mannhalter C

    更新日期:2001-07-01 00:00:00

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    pub_type: 杂志文章


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    journal_title:Thrombosis research

    pub_type: 杂志文章


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    更新日期:1986-11-01 00:00:00

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    journal_title:Thrombosis research

    pub_type: 杂志文章


    authors: Guerrero B,Arocha-Piñango CL

    更新日期:1992-05-01 00:00:00

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    journal_title:Thrombosis research

    pub_type: 杂志文章,评审


    authors: Li Z,Yang F,Dunn S,Gross AK,Smyth SS

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    pub_type: 杂志文章,评审


    authors: Self TH,Oliphant CS,Reaves AB,Richardson AM,Sands CW

    更新日期:2015-01-01 00:00:00