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Geoffrey D Barnes - One of the best experts on this subject based on the ideXlab platform.
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inappropriate prescription of Direct Oral Anticoagulant starter packs
The American Journal of Medicine, 2021Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:Abstract Background The 30-day Direct Oral Anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. Methods A retrospective analysis of national outpatient pharmacy claims data between January 1, 2015 and December 31, 2018, was performed. Adult patients (ages >18 years) with continuous insurance enrollment at least 12 months prior to and 1 month following a Direct Oral Anticoagulant starter pack prescription during the study period were included. The primary study outcome was the rate of inappropriate prescription of Direct Oral Anticoagulant starter packs, defined as a prescription without a venous thromboembolism diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days. Results A total of 3711 Direct Oral Anticoagulant starter pack prescription fills were identified, representing 3634 unique patients. The mean patient age was 62.8 years (standard deviation [SD] 15.1) and 1871 (50.4%) were females. There were 770 (20.7%) Direct Oral Anticoagulant starter pack fills identified as potentially inappropriate. Patients prescribed inappropriate fills were likely to be older than patients with appropriate fills (64.7 years vs 62.4 years, P Conclusions A significant proportion of patients using Direct Oral Anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate Direct Oral Anticoagulant starter pack prescription and evaluate efforts to reduce this practice.
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Adverse outcomes associated with inappropriate Direct Oral Anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study
Journal of Thrombosis and Thrombolysis, 2021Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:Direct Oral Anticoagulant (DOAC) starter packs are designed for unique treatment dosing for acute venous thromboembolism (VTE). Inappropriate use of 30-day DOAC starter packs in patients with atrial fibrillation (AF) may increase the risk for bleeding events given higher dosing in the first 1–3 weeks of treatment. A retrospective analysis of medical and outpatient pharmacy claims data from 2015 to 2018 in Optum’s De-identified Clinformatics® Data Mart was performed. Patients greater than 18 years of age with AF and a new prescription of apixaban or rivaroxaban were included. Patients with an acute VTE were excluded. The main outcome of interest was adverse events (emergency department [ED] visits, hospitalizations, and deaths within 90 days after prescription fill date) associated with inappropriate DOAC starter pack prescription. A total of 90,950 DOAC-treated patients with AF were identified. The mean age was 74.5 years (SD 10.0) and 42,717 (47.0%) were female. Inappropriate starter packs were used by 117 (0.1%) patients, who were younger than non-starter pack patients (71.3 years vs. 74.5 years). Patients who received an inappropriate DOAC prescription were more likely to identify as Black (12.0% vs. 8.8%). Rates of ED visits, hospitalizations, and deaths overall were numerically lower in patients with starter pack compared to non-starter pack DOAC prescriptions. In contrast, rates of ED visits and hospitalizations related to significant bleeding were numerically higher in patients with starter pack compared to non-starter pack DOAC prescriptions. Among patients with AF but no VTE, those who received an inappropriate DOAC starter pack had numerically higher rates of severe bleeding leading to ED visits and hospitalizations compared to those prescribed an appropriate non-starter pack DOAC Anticoagulant.
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Inappropriate Prescription of Direct Oral Anticoagulant Starter Packs.
The American journal of medicine, 2020Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:BACKGROUND The 30-day Direct Oral Anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. METHODS A retrospective analysis of national outpatient pharmacy claims data between January 1, 2015 and December 31, 2018, was performed. Adult patients (ages >18 years) with continuous insurance enrollment at least 12 months prior to and 1 month following a Direct Oral Anticoagulant starter pack prescription during the study period were included. The primary study outcome was the rate of inappropriate prescription of Direct Oral Anticoagulant starter packs, defined as a prescription without a venous thromboembolism diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days. RESULTS A total of 3711 Direct Oral Anticoagulant starter pack prescription fills were identified, representing 3634 unique patients. The mean patient age was 62.8 years (standard deviation [SD] 15.1) and 1871 (50.4%) were females. There were 770 (20.7%) Direct Oral Anticoagulant starter pack fills identified as potentially inappropriate. Patients prescribed inappropriate fills were likely to be older than patients with appropriate fills (64.7 years vs 62.4 years, P < 0.001). There was no significant difference in the race or geographic location between patients with inappropriate and appropriate prescriptions. CONCLUSIONS A significant proportion of patients using Direct Oral Anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate Direct Oral Anticoagulant starter pack prescription and evaluate efforts to reduce this practice.
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evaluation of a pharmacist led outpatient Direct Oral Anticoagulant service
American Journal of Health-system Pharmacy, 2017Co-Authors: Emily J Ashjian, Brian Kurtz, Elizabeth Renner, Robert Yeshe, Geoffrey D BarnesAbstract:Purpose The impact of a pharmacist-led Direct Oral Anticoagulant (DOAC) service on prescription appropriateness and patient adherence was simultaneously evaluated. Methods In this retrospective analysis, patients age 18 years or older for whom a DOAC was prescribed from September 20, 2013, through December 31, 2014, were identified through electronic medical record review of all DOAC prescriptions within the University of Michigan Health System. Patients had their DOAC therapy managed by a pharmacist-led DOAC service or by their physician (usual care). Primary endpoints included the percentage of patients who had appropriate DOAC therapy prescribed at baseline and at follow-up appointments at 3–6 months. Secondary endpoints included mean medication possession ratios (MPRs). Results A total of 258 patients were included in the study, with 129 in each group. Patients in the pharmacist-led DOAC service were significantly more likely to have an appropriate combination of DOAC and dosage prescribed for their indication at baseline compared with the usual care group ( p = 0.009), a finding that persisted at follow up ( p = 0.016). There was no significant difference between groups in the number of patients determined to have an appropriate DOAC prescribed for an approved indication (independent of dose) in the pharmacist-led service (95.3%) versus usual care (93.0%) at baseline. Patients in the pharmacist-led service had a greater mean adjusted MPR compared with the usual care group ( p = 0.0014) over a median follow-up period of 248 days. Conclusion A pharmacist-led DOAC service increased appropriate dosing of DOACs at baseline and follow up as well as patient adherence to therapy.
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prescribing trends of atrial fibrillation patients who switched from warfarin to a Direct Oral Anticoagulant
Journal of Thrombosis and Thrombolysis, 2017Co-Authors: Zachary D Hale, Xiowen Kong, Brian Haymart, Eva Klinerogers, Steve Almany, Jay Kozlowski, Gregory D Krol, Scott Kaatz, James B Froehlich, Geoffrey D BarnesAbstract:Direct Oral Anticoagulant (DOAC) agents offer several lifestyle and therapeutic advantages for patients relative to warfarin in the treatment of atrial fibrillation (AF). These alternative agents are increasingly used in the treatment of AF, however the adoption practices, patient profiles, and reasons for switching to a DOAC from warfarin have not been well studied. Through the Michigan Anticoagulation Quality Improvement Initiative, abstracted data from 3873 AF patients, enrolled between 2010 and 2015, were collected on demographics and comorbid conditions, stroke and bleeding risk scores, and reasons for Anticoagulant switching. Over the study period, patients who switched from warfarin to a DOAC had similar baseline characteristics, risk scores, and insurance status but differed in baseline CrCl. The most common reasons for switching were patient related ease of use concerns (37.5%) as opposed to clinical reasons (16.5% of patients). Only 13% of patients that switched to a DOAC switched back to warfarin by the end of the study period.
Yilin Feng - One of the best experts on this subject based on the ideXlab platform.
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inappropriate prescription of Direct Oral Anticoagulant starter packs
The American Journal of Medicine, 2021Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:Abstract Background The 30-day Direct Oral Anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. Methods A retrospective analysis of national outpatient pharmacy claims data between January 1, 2015 and December 31, 2018, was performed. Adult patients (ages >18 years) with continuous insurance enrollment at least 12 months prior to and 1 month following a Direct Oral Anticoagulant starter pack prescription during the study period were included. The primary study outcome was the rate of inappropriate prescription of Direct Oral Anticoagulant starter packs, defined as a prescription without a venous thromboembolism diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days. Results A total of 3711 Direct Oral Anticoagulant starter pack prescription fills were identified, representing 3634 unique patients. The mean patient age was 62.8 years (standard deviation [SD] 15.1) and 1871 (50.4%) were females. There were 770 (20.7%) Direct Oral Anticoagulant starter pack fills identified as potentially inappropriate. Patients prescribed inappropriate fills were likely to be older than patients with appropriate fills (64.7 years vs 62.4 years, P Conclusions A significant proportion of patients using Direct Oral Anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate Direct Oral Anticoagulant starter pack prescription and evaluate efforts to reduce this practice.
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Adverse outcomes associated with inappropriate Direct Oral Anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study
Journal of Thrombosis and Thrombolysis, 2021Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:Direct Oral Anticoagulant (DOAC) starter packs are designed for unique treatment dosing for acute venous thromboembolism (VTE). Inappropriate use of 30-day DOAC starter packs in patients with atrial fibrillation (AF) may increase the risk for bleeding events given higher dosing in the first 1–3 weeks of treatment. A retrospective analysis of medical and outpatient pharmacy claims data from 2015 to 2018 in Optum’s De-identified Clinformatics® Data Mart was performed. Patients greater than 18 years of age with AF and a new prescription of apixaban or rivaroxaban were included. Patients with an acute VTE were excluded. The main outcome of interest was adverse events (emergency department [ED] visits, hospitalizations, and deaths within 90 days after prescription fill date) associated with inappropriate DOAC starter pack prescription. A total of 90,950 DOAC-treated patients with AF were identified. The mean age was 74.5 years (SD 10.0) and 42,717 (47.0%) were female. Inappropriate starter packs were used by 117 (0.1%) patients, who were younger than non-starter pack patients (71.3 years vs. 74.5 years). Patients who received an inappropriate DOAC prescription were more likely to identify as Black (12.0% vs. 8.8%). Rates of ED visits, hospitalizations, and deaths overall were numerically lower in patients with starter pack compared to non-starter pack DOAC prescriptions. In contrast, rates of ED visits and hospitalizations related to significant bleeding were numerically higher in patients with starter pack compared to non-starter pack DOAC prescriptions. Among patients with AF but no VTE, those who received an inappropriate DOAC starter pack had numerically higher rates of severe bleeding leading to ED visits and hospitalizations compared to those prescribed an appropriate non-starter pack DOAC Anticoagulant.
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Inappropriate Prescription of Direct Oral Anticoagulant Starter Packs.
The American journal of medicine, 2020Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:BACKGROUND The 30-day Direct Oral Anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. METHODS A retrospective analysis of national outpatient pharmacy claims data between January 1, 2015 and December 31, 2018, was performed. Adult patients (ages >18 years) with continuous insurance enrollment at least 12 months prior to and 1 month following a Direct Oral Anticoagulant starter pack prescription during the study period were included. The primary study outcome was the rate of inappropriate prescription of Direct Oral Anticoagulant starter packs, defined as a prescription without a venous thromboembolism diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days. RESULTS A total of 3711 Direct Oral Anticoagulant starter pack prescription fills were identified, representing 3634 unique patients. The mean patient age was 62.8 years (standard deviation [SD] 15.1) and 1871 (50.4%) were females. There were 770 (20.7%) Direct Oral Anticoagulant starter pack fills identified as potentially inappropriate. Patients prescribed inappropriate fills were likely to be older than patients with appropriate fills (64.7 years vs 62.4 years, P < 0.001). There was no significant difference in the race or geographic location between patients with inappropriate and appropriate prescriptions. CONCLUSIONS A significant proportion of patients using Direct Oral Anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate Direct Oral Anticoagulant starter pack prescription and evaluate efforts to reduce this practice.
Chihwen Pai - One of the best experts on this subject based on the ideXlab platform.
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inappropriate prescription of Direct Oral Anticoagulant starter packs
The American Journal of Medicine, 2021Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:Abstract Background The 30-day Direct Oral Anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. Methods A retrospective analysis of national outpatient pharmacy claims data between January 1, 2015 and December 31, 2018, was performed. Adult patients (ages >18 years) with continuous insurance enrollment at least 12 months prior to and 1 month following a Direct Oral Anticoagulant starter pack prescription during the study period were included. The primary study outcome was the rate of inappropriate prescription of Direct Oral Anticoagulant starter packs, defined as a prescription without a venous thromboembolism diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days. Results A total of 3711 Direct Oral Anticoagulant starter pack prescription fills were identified, representing 3634 unique patients. The mean patient age was 62.8 years (standard deviation [SD] 15.1) and 1871 (50.4%) were females. There were 770 (20.7%) Direct Oral Anticoagulant starter pack fills identified as potentially inappropriate. Patients prescribed inappropriate fills were likely to be older than patients with appropriate fills (64.7 years vs 62.4 years, P Conclusions A significant proportion of patients using Direct Oral Anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate Direct Oral Anticoagulant starter pack prescription and evaluate efforts to reduce this practice.
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Adverse outcomes associated with inappropriate Direct Oral Anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study
Journal of Thrombosis and Thrombolysis, 2021Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:Direct Oral Anticoagulant (DOAC) starter packs are designed for unique treatment dosing for acute venous thromboembolism (VTE). Inappropriate use of 30-day DOAC starter packs in patients with atrial fibrillation (AF) may increase the risk for bleeding events given higher dosing in the first 1–3 weeks of treatment. A retrospective analysis of medical and outpatient pharmacy claims data from 2015 to 2018 in Optum’s De-identified Clinformatics® Data Mart was performed. Patients greater than 18 years of age with AF and a new prescription of apixaban or rivaroxaban were included. Patients with an acute VTE were excluded. The main outcome of interest was adverse events (emergency department [ED] visits, hospitalizations, and deaths within 90 days after prescription fill date) associated with inappropriate DOAC starter pack prescription. A total of 90,950 DOAC-treated patients with AF were identified. The mean age was 74.5 years (SD 10.0) and 42,717 (47.0%) were female. Inappropriate starter packs were used by 117 (0.1%) patients, who were younger than non-starter pack patients (71.3 years vs. 74.5 years). Patients who received an inappropriate DOAC prescription were more likely to identify as Black (12.0% vs. 8.8%). Rates of ED visits, hospitalizations, and deaths overall were numerically lower in patients with starter pack compared to non-starter pack DOAC prescriptions. In contrast, rates of ED visits and hospitalizations related to significant bleeding were numerically higher in patients with starter pack compared to non-starter pack DOAC prescriptions. Among patients with AF but no VTE, those who received an inappropriate DOAC starter pack had numerically higher rates of severe bleeding leading to ED visits and hospitalizations compared to those prescribed an appropriate non-starter pack DOAC Anticoagulant.
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Inappropriate Prescription of Direct Oral Anticoagulant Starter Packs.
The American journal of medicine, 2020Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:BACKGROUND The 30-day Direct Oral Anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. METHODS A retrospective analysis of national outpatient pharmacy claims data between January 1, 2015 and December 31, 2018, was performed. Adult patients (ages >18 years) with continuous insurance enrollment at least 12 months prior to and 1 month following a Direct Oral Anticoagulant starter pack prescription during the study period were included. The primary study outcome was the rate of inappropriate prescription of Direct Oral Anticoagulant starter packs, defined as a prescription without a venous thromboembolism diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days. RESULTS A total of 3711 Direct Oral Anticoagulant starter pack prescription fills were identified, representing 3634 unique patients. The mean patient age was 62.8 years (standard deviation [SD] 15.1) and 1871 (50.4%) were females. There were 770 (20.7%) Direct Oral Anticoagulant starter pack fills identified as potentially inappropriate. Patients prescribed inappropriate fills were likely to be older than patients with appropriate fills (64.7 years vs 62.4 years, P < 0.001). There was no significant difference in the race or geographic location between patients with inappropriate and appropriate prescriptions. CONCLUSIONS A significant proportion of patients using Direct Oral Anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate Direct Oral Anticoagulant starter pack prescription and evaluate efforts to reduce this practice.
Kristian Seiler - One of the best experts on this subject based on the ideXlab platform.
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inappropriate prescription of Direct Oral Anticoagulant starter packs
The American Journal of Medicine, 2021Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:Abstract Background The 30-day Direct Oral Anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. Methods A retrospective analysis of national outpatient pharmacy claims data between January 1, 2015 and December 31, 2018, was performed. Adult patients (ages >18 years) with continuous insurance enrollment at least 12 months prior to and 1 month following a Direct Oral Anticoagulant starter pack prescription during the study period were included. The primary study outcome was the rate of inappropriate prescription of Direct Oral Anticoagulant starter packs, defined as a prescription without a venous thromboembolism diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days. Results A total of 3711 Direct Oral Anticoagulant starter pack prescription fills were identified, representing 3634 unique patients. The mean patient age was 62.8 years (standard deviation [SD] 15.1) and 1871 (50.4%) were females. There were 770 (20.7%) Direct Oral Anticoagulant starter pack fills identified as potentially inappropriate. Patients prescribed inappropriate fills were likely to be older than patients with appropriate fills (64.7 years vs 62.4 years, P Conclusions A significant proportion of patients using Direct Oral Anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate Direct Oral Anticoagulant starter pack prescription and evaluate efforts to reduce this practice.
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Adverse outcomes associated with inappropriate Direct Oral Anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study
Journal of Thrombosis and Thrombolysis, 2021Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:Direct Oral Anticoagulant (DOAC) starter packs are designed for unique treatment dosing for acute venous thromboembolism (VTE). Inappropriate use of 30-day DOAC starter packs in patients with atrial fibrillation (AF) may increase the risk for bleeding events given higher dosing in the first 1–3 weeks of treatment. A retrospective analysis of medical and outpatient pharmacy claims data from 2015 to 2018 in Optum’s De-identified Clinformatics® Data Mart was performed. Patients greater than 18 years of age with AF and a new prescription of apixaban or rivaroxaban were included. Patients with an acute VTE were excluded. The main outcome of interest was adverse events (emergency department [ED] visits, hospitalizations, and deaths within 90 days after prescription fill date) associated with inappropriate DOAC starter pack prescription. A total of 90,950 DOAC-treated patients with AF were identified. The mean age was 74.5 years (SD 10.0) and 42,717 (47.0%) were female. Inappropriate starter packs were used by 117 (0.1%) patients, who were younger than non-starter pack patients (71.3 years vs. 74.5 years). Patients who received an inappropriate DOAC prescription were more likely to identify as Black (12.0% vs. 8.8%). Rates of ED visits, hospitalizations, and deaths overall were numerically lower in patients with starter pack compared to non-starter pack DOAC prescriptions. In contrast, rates of ED visits and hospitalizations related to significant bleeding were numerically higher in patients with starter pack compared to non-starter pack DOAC prescriptions. Among patients with AF but no VTE, those who received an inappropriate DOAC starter pack had numerically higher rates of severe bleeding leading to ED visits and hospitalizations compared to those prescribed an appropriate non-starter pack DOAC Anticoagulant.
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Inappropriate Prescription of Direct Oral Anticoagulant Starter Packs.
The American journal of medicine, 2020Co-Authors: Yilin Feng, Chihwen Pai, Kristian Seiler, Geoffrey D BarnesAbstract:BACKGROUND The 30-day Direct Oral Anticoagulant starter pack has simplified the treatment of acute venous thromboembolisms, but it is not appropriate for use in patients with other indications for anticoagulation. METHODS A retrospective analysis of national outpatient pharmacy claims data between January 1, 2015 and December 31, 2018, was performed. Adult patients (ages >18 years) with continuous insurance enrollment at least 12 months prior to and 1 month following a Direct Oral Anticoagulant starter pack prescription during the study period were included. The primary study outcome was the rate of inappropriate prescription of Direct Oral Anticoagulant starter packs, defined as a prescription without a venous thromboembolism diagnosis within the prior 45 days or a prescription with a prior starter pack fill within the past 45 days. RESULTS A total of 3711 Direct Oral Anticoagulant starter pack prescription fills were identified, representing 3634 unique patients. The mean patient age was 62.8 years (standard deviation [SD] 15.1) and 1871 (50.4%) were females. There were 770 (20.7%) Direct Oral Anticoagulant starter pack fills identified as potentially inappropriate. Patients prescribed inappropriate fills were likely to be older than patients with appropriate fills (64.7 years vs 62.4 years, P < 0.001). There was no significant difference in the race or geographic location between patients with inappropriate and appropriate prescriptions. CONCLUSIONS A significant proportion of patients using Direct Oral Anticoagulant starter packs did not have a diagnosis of acute venous thromboembolism, raising concerns about inappropriate prescribing and potential bleeding complications. Future studies are needed to identify factors associated with inappropriate Direct Oral Anticoagulant starter pack prescription and evaluate efforts to reduce this practice.
Gary H Lyman - One of the best experts on this subject based on the ideXlab platform.
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Direct Oral Anticoagulant for the prevention of thrombosis in ambulatory patients with cancer a systematic review and meta analysis
Journal of Thrombosis and Haemostasis, 2019Co-Authors: Nicole M Kuderer, Marc Carrier, David A Garcia, Alok A Khorana, Philip S Wells, Gary H LymanAbstract:Background It is unclear if Direct Oral Anticoagulant (DOAC) is efficacious and safe for prophylaxis of venous thromboembolism (VTE) in ambulatory patients with cancer. Methods We performed a systematic review using EMBASE, MEDLINE, and CENTRAL. Inclusion criteria included adult ambulatory patients with cancer, prophylactic use of DOAC, and randomized controlled trials. Exclusion criteria included pediatric patients, inpatient or postoperative setting, therapeutic indication of DOAC, or non-phase III randomized controlled trial. Two authors screened/reviewed articles and abstracted the data. Meta-analysis was performed using random-effects model. Efficacy outcome included overall and symptomatic VTE incidence during the first 6 months. Safety outcomes included major bleeding and clinically relevant non-major bleeding (CRNMB) incidence during the on-treatment period. Subgroup analysis was performed for intermediate- and high-risk Khorana score. Results A total of 202 records were identified and 28 full-text articles were assessed. Two studies with 1415 participants were included for meta-analysis. For DOAC vs placebo, the relative risks for overall and symptomatic VTE incidence by 6 months were 0.56 (0.35-0.89) and 0.58 (0.29-1.13), respectively. The relative risks for major bleeding and CRNMB while on-treatment were 1.96 (0.80-4.82) and 1.28 (0.74-2.20), respectively. Patients with high-risk Khorana score (3+) derived the largest absolute risk reduction of VTE. Conclusions Low-dose DOAC reduces the rate of overall VTE in higher risk cancer patients starting systemic chemotherapy. It may reduce the rate of symptomatic VTE but increase the likelihood of bleeding.
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cost effectiveness analysis of Direct Oral Anticoagulant doac versus dalteparin for the treatment of cancer associated thrombosis cat in the united states
Thrombosis Research, 2019Co-Authors: Ang Li, David A Garcia, Gary H Lyman, Poorni Manohar, Lotte M G SteutenAbstract:Abstract Introduction While trials have demonstrated non-inferiority of Direct Oral Anticoagulant drugs (DOAC) to low-molecular-weight heparins (LMWH) for the treatment of cancer associated thrombosis (CAT), it is unclear if the newer intervention is cost-effective. Methods We performed a cost-utility analysis using a Markov state-transition model over a time horizon of 60 months in a hypothetical cohort of 65-year-old patients with active malignancy and first acute symptomatic CAT who were eligible to receive either rivaroxaban/edoxaban or dalteparin. We obtained transition probability, relative risk, cost, and utility inputs from the literature. We estimated the differential impact on costs and quality-adjusted life years (QALYs) per patient and performed one-way and probabilistic sensitivity analyses to test the robustness of results. Results Using the base-case analysis over 60 months, DOAC versus dalteparin was associated with an incremental cost reduction of $24,129 with an incremental QALY reduction of 0.04. In the one-way sensitivity analysis, the cost of dalteparin contributed the most to the incremental cost difference; relative risk of death related to underlying cancer contributed the most of the incremental QALY difference. The probabilistic sensitivity analysis confirmed the base-case analysis, with a large reduction in cost but small reduction in QALYs. Conclusion Rivaroxaban or edoxaban as compared to dalteparin is cost saving from a payer's perspective for the treatment of CAT. Professional organizations and healthcare systems may want to consider this analysis in future practice recommendations.