We analysed time trends in the
pulmonary embolism (PE) mortality rates in Germany from 2004 and assessed for an association between the use of
anticoagulants and PE caused mortality. We extracted age-specific number of deaths due to PE (ICD-10 I26) from 2004 to 2011 as available from the WHO mortality databases. In addition we derived defined daily dosage (
DDD) of prescribed
anticoagulants and the low molecular
heparin Enoxaparin for the years 2004-2011 from the statutory health insurance-
drug-information system reports. Age-standardized PE mortality per 100,000 decreased from 5.9283 in year 2004 to 4.4876 in 2011 (-24.3 %). Amounts of prescribed
anticoagulants increased in this period from 271,810.7 × 1000
DDD to 416,611.8 × 1000
DDD (+53.3 %), that of
Enoxaparin increased from 27,071.1 × 1000
DDD in 2004 97,276.5 × 1000
DDD in 2011. The PE mortality is negatively correlated with
anticoagulants (-0.9463, p = 0.0004) as well as with
enoxaparin (-0.9740, p < 0.0001) and of
DDD of
Enoxaparin per 1000 insured (-0.9682, p < 0.0001). In univariate linear regression model,
anticoagulants,
Enoxaparin and
Enoxaparin per 1000 insured all reach significance (p = 0.0004, p = 4.31 × 10(-5) and p = 0.0001 respectively). Multiple regression models show that
Enoxaparin has the most robust effect. Including the time trend in the model does not alter the results. Our study shows that increasing number of prescribed
Enoxaparin in an outpatient setting might be one determinant of decreasing PE mortality rate in Germany since 2004.