Abstract Body: Background: Disparities in anticoagulation therapy, driven by race, age, and insurance status, affect access to direct oral anticoagulants (DOACs). These factors also influence discharge disposition across patient groups.

Objective: To assess differences in anticoagulation therapy and discharge dispositions between self-pay and insured patients, with a focus on age and race.

Methods: This retrospective cohort study analyzed 3,966 patients discharged on anticoagulation therapy for atrial fibrillation (AF), deep vein thrombosis (DVT), or pulmonary embolism (PE). Patients were drawn from neurology, cardiology, and other services. Descriptive statistics were used to compare trends across these groups.

Results: Of the 3,966 patients, AF was the most common diagnosis (47.16% self-pay, 67.14% insured), followed by DVT and PE. DOACs were used in 59.09% of self-pay and 65.38% of insured AF patients, while warfarin was more common in self-pay AF patients (25.00% vs. 21.61%). DOAC use in DVT was 82.00% for self-pay and 78.39% for insured patients. For PE, 95.65% of self-pay and 72.40% of insured patients were discharged on DOACs. Warfarin use peaked at 27.6% for insured patients aged 70-79. Non-White self-pay patients were less likely to be discharged on DOACs compared to White patients. Specifically, 52.46% of African American self-pay patients were discharged on DOACs compared to 73.91% of White self-pay patients and 50.85% of patients from other racial backgrounds. Warfarin use was higher among non-White self-pay patients. In the insured group, DOAC usage was consistent across racial groups, with 64.71% of African American patients, 65.06% of White patients, and 63.47% of patients from other racial backgrounds discharged on DOACs. Asian patients had lower overall anticoagulant usage. Discharge disposition varied by age and insurance status; insured elderly patients were more likely to be discharged to extended care facilities. Gender disparities were also observed, with more self-pay males discharged to skilled nursing facilities compared to females (3.8% vs. 0.9%).

Conclusion: Among insured patients, age was a more significant factor than race in determining warfarin use, with older patients more likely to receive warfarin. In contrast, among self-pay patients, non-Whites were less likely to be discharged on DOACs, highlighting the influence of race and financial status on anticoagulation therapy.