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6. A Real-World Observational Study of Hospitalization and Health Care Costs Among Nonvalvular Atrial Fibrillation Patients Prescribed Oral Anticoagulants in the U.S. Medicare Population.

Author

Keshishian, Allison, Trocio, Jeffrey, Dina, Oluwaseyi, Le, Hannah, Rosenblatt, Lisa, Liu, Xianchen, Mardekian, Jack, Zhang, Qisu, Baser, Onur, Nadkarni, Anagha, Vo, Lien, and Amin, Alpesh

Subjects
Aged, Anticoagulants, Atrial Fibrillation, Databases, Factual, Female, Health Care Costs, Hospitalization, Humans, Male, Medicare, Middle Aged, Retrospective Studies, United States
Abstract

UNLABELLED: This article has been corrected. Please see J Manag Care Spec Pharm, 2020;26(5):682 BACKGROUND: Clinical trials have shown that direct oral anticoagulants (DOACs)-including dabigatran, rivaroxaban, apixaban, and edoxaban-are at least as effective and safe as warfarin for the risk of stroke/systemic embolism (SE) and major bleeding (MB) in patients with atrial fibrillation (AF). However, few studies have compared oral anticoagulants (OACs) among elderly patients. OBJECTIVE: To compare hospitalization risks (all-cause, stroke/SE-related, and MB-related) and associated health care costs among elderly nonvalvular AF (NVAF) patients in the Medicare population who initiated warfarin, dabigatran, rivaroxaban, or apixaban. METHODS: Patients (aged ≥ 65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Centers for Medicare & Medicaid Services database from January 1, 2013, to December 31, 2014. Patients initiating each OAC were matched 1:1 to apixaban patients using propensity score matching to balance demographic and clinical characteristics. Cox proportional hazards models were used to estimate the risk of hospitalization of each OAC versus apixaban. Generalized linear models and two-part models with bootstrapping were used to compare all-cause health care costs and stroke/SE- and MB-related medical costs between matched cohorts. RESULTS: Of the 264,479 eligible patients, 77,480 warfarin-apixaban, 41,580 dabigatran-apixaban, and 77,640 rivaroxaban-apixaban patients were matched. The OACs were associated with a significantly higher risk of all-cause hospitalization compared with apixaban (warfarin: HR = 1.27, 95% CI = 1.23-1.31, P < 0.001; dabigatran: HR = 1.13, 95% CI = 1.08-1.18, P < 0.001; and rivaroxaban: HR = 1.22, 95% CI = 1.18-1.26, P < 0.001) and were associated with a significantly higher risk of hospitalization due to stroke/SE (warfarin: HR = 2.18, 95% CI = 1.80-2.64, P < 0.001; dabigatran: HR = 1.45, 95% CI = 1.12-1.88, P = 0.006; and rivaroxaban: HR = 1.40, 95% CI = 1.14-1.71, P = 0.001). Also, the OACs were associated with significantly higher risk of hospitalization due to MB-related conditions compared with apixaban (warfarin: HR = 1.76, 95% CI = 1.59-1.95, P < 0.001; dabigatran: HR = 1.44, 95% CI = 1.23-1.68, P < 0.001; and rivaroxaban: HR = 1.89, 95% CI = 1.71-2.09, P < 0.001). Compared with apixaban, warfarin ($3,577 vs. $3,183, P < 0.001); dabigatran ($3,217 vs. $3,060, P < 0.001); and rivaroxaban ($3,878 vs. $3,180, P < 0.001) had significantly higher all-cause total health care costs per patient per month. Patients initiating the OACs had significantly higher MB-related medical costs compared with apixaban: warfarin ($472 vs. $269; P < 0.001); dabigatran ($364 vs. $245, P < 0.001); and rivaroxaban ($493 vs. $270, P < 0.001). Warfarin was also associated with higher stroke/SE-related medical costs compared with apixaban ($124 vs. $62, P < 0.001). CONCLUSIONS: This real-world study showed that among elderly NVAF patients in the Medicare population, apixaban was associated with significantly lower risks of all-cause, stroke/SE-related, and MB-related hospitalizations compared with warfarin, dabigatran, and rivaroxaban. Accordingly, apixaban showed significantly lower all-cause health care costs and MB-related medical costs. DISCLOSURES: This study was funded by Bristol Myers Squibb and Pfizer. Amin is an employee of the University of California, Irvine, and was a paid consultant to Bristol Myers Squibb in connection with this study and the development of this manuscript. He has served as a consultant and/or speaker for Bristol Myers Squibb, Pfizer, and Boehringer Ingelheim. Keshishian and Zhang are employees of STATinMED Research, a paid consultant to Pfizer and Bristol Myers Squibb in connection with this study and the development of this manuscript. Trocio, Dina, Mardekian, and Liu are employees of Pfizer, with ownership of stocks in Pfizer. Le, Rosenblatt, Nadkarni, and Vo are employees of Bristol Myers Squibb. Rosenblatt and Vo have ownership of stocks in Bristol Myers Squibb. Baser has no conflicts to disclose.

Published
2020

7. Association Between Bilirubin, Atazanavir, and Cardiovascular Disease Events Among People Living With HIV Across the United States.

Author

Crane, Heidi M, Nance, Robin M, Heckbert, Susan R, Ritchings, Corey, Rosenblatt, Lisa, Budoff, Matthew, Wood, Brian R, Tirschwell, David L, Kim, H Nina, Mathews, William C, Geng, Elvin, Moore, Richard D, Hunt, Peter W, Eron, Joseph J, Burkholder, Greer A, Drozd, Daniel R, Chow, Felicia C, Becker, Kyra J, Zunt, Joseph R, Ho, Emily L, Kalani, Rizwan, Huffer, Andrew, Whitney, Bridget M, Saag, Michael S, Kitahata, Mari M, and Delaney, Joseph AC

Subjects
Biomedical and Clinical Sciences, Public Health, Health Sciences, Sexually Transmitted Infections, Hematology, Prevention, Heart Disease - Coronary Heart Disease, Infectious Diseases, Cardiovascular, HIV/AIDS, Heart Disease, Good Health and Well Being, Adult, Atazanavir Sulfate, Bilirubin, Female, HIV Infections, HIV Protease Inhibitors, Humans, Male, Middle Aged, Myocardial Infarction, United States, HIV, myocardial infarction, atazanavir, bilirubin, stroke, cardiovascular disease, Clinical Sciences, Public Health and Health Services, Virology, Clinical sciences, Epidemiology, Public health
Abstract

ObjectiveBilirubin is an antioxidant that may suppress lipid oxidation. Elevated bilirubin is associated with decreased cardiovascular events in HIV-uninfected populations. We examined these associations in people living with HIV (PLWH).MethodsPotential myocardial infarctions (MIs) and strokes were centrally adjudicated. We examined MI types: type 1 MI (T1MI) from atherosclerotic plaque instability and type 2 MI (T2MI) in the setting of oxygen demand/supply mismatch such as sepsis. We used multivariable Cox regression analyses to determine associations between total bilirubin levels and outcomes adjusting for traditional and HIV-specific risk factors. To minimize confounding by hepatobiliary disease, we conducted analyses limited to bilirubin values

Published
2019

8. Comparative clinical outcomes between direct oral anticoagulants and warfarin among elderly patients with non-valvular atrial fibrillation in the CMS medicare population

Author

Amin, Alpesh, Keshishian, Allison, Dina, Oluwaseyi, Dhamane, Amol, Nadkarni, Anagha, Carda, Eric, Russ, Cristina, Rosenblatt, Lisa, Mardekian, Jack, Yuce, Huseyin, and Baker, Christine L

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Aging, Cardiovascular, Brain Disorders, Clinical Research, Hematology, Heart Disease, Aged, Aged, 80 and over, Anticoagulants, Antithrombins, Atrial Fibrillation, Cardiovascular Diseases, Dabigatran, Factor Xa Inhibitors, Hemorrhage, Humans, Medicare, Pyrazoles, Pyridones, Retrospective Studies, Rivaroxaban, Stroke, Treatment Outcome, United States, Warfarin, Apixaban, Non-valvular atrial fibrillation, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences
Abstract

Atrial fibrillation (AF) prevalence increases with age; > 80% of US adults with AF are aged ≥ 65 years. Compare the risk of stroke/systemic embolism (SE), major bleeding (MB), net clinical outcome (NCO), and major adverse cardiac events (MACE) among elderly non-valvular AF (NVAF) Medicare patients prescribed direct oral anticoagulants (DOACs) VS warfarin. NVAF patients aged ≥ 65 years who initiated DOACs (apixaban, dabigatran, and rivaroxaban) or warfarin were selected from 01JAN2013-31DEC2015 in CMS Medicare data. Propensity score matching was used to balance DOAC and warfarin cohorts. Cox proportional hazards models estimated the risk of stroke/SE, MB, NCO, and MACE. 37,525 apixaban-warfarin, 18,131 dabigatran-warfarin, and 55,359 rivaroxaban-warfarin pairs were included. Compared to warfarin, apixaban (HR: 0.69; 95% CI 0.59-0.81) and rivaroxaban (HR: 0.82; 95% CI 0.73-0.91) had lower risk of stroke/SE, and dabigatran (HR: 0.88; 95% CI 0.72-1.07) had similar risk of stroke/SE. Apixaban (MB: HR: 0.61; 95% CI 0.57-0.67; NCO: HR: 0.64; 95% CI 0.60-0.69) and dabigatran (MB: HR: 0.79; 95% CI 0.71-0.89; NCO: HR: 0.84; 95% CI 0.76-0.93) had lower risk of MB and NCO, and rivaroxaban had higher risk of MB (HR: 1.08; 95% CI 1.02-1.14) and similar risk of NCO (HR: 1.04; 95% CI 0.99-1.09). Compared to warfarin, apixaban had a lower risk for stroke/SE, MB, and NCO; dabigatran had a lower risk of MB and NCO; and rivaroxaban had a lower risk of stroke/SE but higher risk of MB. All DOACs had lower risk of MACE compared to warfarin.

Published
2019

9. Effectiveness and safety of oral anticoagulants in older adults with non-valvular atrial fibrillation and heart failure

Author

Amin, Alpesh, Reeves, Alessandra B Garcia, Li, Xiaoyan, Dhamane, Amol, Luo, Xuemei, Di Fusco, Manuela, Nadkarni, Anagha, Friend, Keith, Rosenblatt, Lisa, Mardekian, Jack, Pan, Xianying, Yuce, Huseyin, and Keshishian, Allison

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Heart Disease, Clinical Research, Cardiovascular, Hematology, Administration, Oral, Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Dabigatran, Female, Heart Failure, Humans, Incidence, Kaplan-Meier Estimate, Male, Medicare, Patient Safety, Proportional Hazards Models, Pyrazoles, Pyridones, Retrospective Studies, Risk, Rivaroxaban, Treatment Outcome, United States, Warfarin, General Science & Technology
Abstract

Direct oral anticoagulants (DOACs) are at least as efficacious and safe as warfarin among non-valvular atrial fibrillation (NVAF) patients; limited evidence is available regarding NVAF patients with heart failure (HF). US Medicare enrollees with NVAF and HF initiating DOACs (apixaban, rivaroxaban, dabigatran) or warfarin were selected. Propensity score matching and Cox models were used to estimate the risk of stroke/systemic embolism (SE), major bleeding (MB), and major adverse cardiac events (MACE) comparing DOACs versus warfarin and DOACs versus DOACs. We identified 10,570 apixaban-warfarin, 4,297 dabigatran-warfarin, 15,712 rivaroxaban-warfarin, 4,263 apixaban-dabigatran, 10,477 apixaban-rivaroxaban, and 4,297 dabigatran-rivaroxaban matched pairs. Compared to warfarin, apixaban had lower rates of stroke/SE (hazard ratio = 0.64, 95% confidence interval = 0.48-0.85), MB (hazard ratio = 0.66, 0.58-0.76), and MACE (hazard ratio = 0.73,0.67-0.79); dabigatran and rivaroxaban had lower rates of MACE (hazard ratio = 0.87,0.77-0.99; hazard ratio = 0.84, 0.79-0.89, respectively). Rivaroxaban had a lower stroke/SE rate (hazard ratio = 0.65, 0.52-0.81) and higher MB rate (hazard ratio = 1.18, 1.08-1.30) versus warfarin. Compared to dabigatran and rivaroxaban, apixaban had lower MB (hazard ratio = 0.71, 0.57-0.89; hazard ratio = 0.55, 0.49-0.63) and MACE rates (hazard ratio = 0.80, 0.69-0.93; hazard ratio = 0.86, 0.79-0.94), respectively. All DOACs had lower MACE rates versus warfarin; differences were observed in stroke/SE and MB. Our findings provide insights about OAC therapy among NVAF patients with HF.

Published
2019

10. Differentiation of Type 1 and Type 2 Myocardial Infarctions Among HIV-Infected Patients Requires Adjudication Due to Overlap in Risk Factors

Author

Nance, Robin M, Crane, Heidi M, Ritchings, Corey, Rosenblatt, Lisa, Budoff, Matthew, Heckbert, Susan R, Drozd, Daniel R, Mathews, William C, Geng, Elvin, Hunt, Peter W, Feinstein, Matthew J, Moore, Richard D, Hsue, Priscilla, Eron, Joseph J, Burkholder, Greer A, Rodriguez, Benigno, Mugavero, Michael J, Saag, Michael S, Kitahata, Mari M, and Delaney, Joseph AC

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Prevention, Sexually Transmitted Infections, Cardiovascular, Infectious Diseases, Heart Disease - Coronary Heart Disease, Heart Disease, HIV/AIDS, Infection, Good Health and Well Being, Adult, Bayes Theorem, Cohort Studies, Diagnosis, Differential, Female, HIV Infections, Humans, Male, Middle Aged, Models, Statistical, Myocardial Infarction, Risk Factors, myocardial infarction, adjudication, HIV, cardiovascular disease, cohort research, Bayesian model averaging, Clinical Sciences, Virology, Clinical sciences
Abstract

The Universal Myocardial infarction (MI) definition divides MIs into different types. Type 1 MIs (T1MI) result spontaneously from atherosclerotic plaque instability. Type 2 MIs (T2MI) are due to secondary causes of myocardial oxygen demand/supply mismatch such as occurs with sepsis. T2MI are much more common among those with HIV than in the general population. T1MI and T2MI have different mechanisms, risk factors, and potential treatments suggesting that they should be distinguished to achieve a better scientific understanding of MIs in HIV. We sought to determine whether MI type could be accurately predicted by patient characteristics without adjudication in HIV-infected individuals. We developed a statistical model to predict T2MI versus T1MI using adjudicated events from six sites utilizing demographic characteristics, traditional cardiovascular, and HIV-related risk factors. Validation was assessed in a seventh site via mean calibration, and discrimination level was assessed by the area under the curve (AUC). Of 812 MIs, 388 were T2MI. HIV-related factors including hepatitis C infection were predictive of T2MI, whereas traditional cardiovascular risk factors including total cholesterol predicted T1MI. The score predicted 69 T2MI in the validation sample resulting in poor calibration, given that 90 T2MIs were observed. The development sample AUC was 0.75 versus 0.65 in the validation sample, suggesting relatively poor discrimination. The level of discrimination to predict MI type based on patient characteristics is insufficient for individual level prediction. Adjudication is required to distinguish MI types, which is necessary to advance understanding of this important outcome among HIV populations.

Published
2018

11. A Real-World Observational Study of Hospitalization and Health Care Costs Among Nonvalvular Atrial Fibrillation Patients Prescribed Oral Anticoagulants in the U.S. Medicare Population.

Author

Keshishian, Allison, Trocio, Jeffrey, Dina, Oluwaseyi, Le, Hannah, Rosenblatt, Lisa, Liu, Xianchen, Mardekian, Jack, Zhang, Qisu, Baser, Onur, Nadkarni, Anagha, Vo, Lien, and Amin, Alpesh

Subjects
Administration, Oral, Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Female, Health Care Costs, Hospitalization, Humans, Male, Medicare, Retrospective Studies, Stroke, United States
Abstract

BACKGROUND: Clinical trials have shown that direct oral anticoagulants (DOACs)-including dabigatran, rivaroxaban, apixaban, and edoxaban-are at least as effective and safe as warfarin for the risk of stroke/systemic embolism (SE) and major bleeding (MB) in patients with atrial fibrillation (AF). However, few studies have compared oral anticoagulants (OACs) among elderly patients. OBJECTIVE: To compare hospitalization risks (all-cause, stroke/SE-related, and MB-related) and associated health care costs among elderly nonvalvular AF (NVAF) patients in the Medicare population who initiated warfarin, dabigatran, rivaroxaban, or apixaban. METHODS: Patients (aged ≥ 65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Centers for Medicare & Medicaid Services database from January 1, 2013, to December 31, 2014. Patients initiating each OAC were matched 1:1 to apixaban patients using propensity score matching to balance demographic and clinical characteristics. Cox proportional hazards models were used to estimate the risk of hospitalization of each OAC versus apixaban. Generalized linear models and two-part models with bootstrapping were used to compare all-cause health care costs and stroke/SE- and MB-related medical costs between matched cohorts. RESULTS: Of the 186,132 eligible patients, 41,606 warfarin-apixaban, 30,836 dabigatran-apixaban, and 41,608 rivaroxaban-apixaban pairs were matched. The OACs were associated with a significantly higher risk of all-cause hospitalization compared with apixaban (warfarin: HR = 1.33, 95% CI = 1.27-1.38, P < 0.001; dabigatran: HR = 1.17, 95% CI = 1.11-1.23, P < 0.001; and rivaroxaban: HR = 1.27, 95% CI = 1.22-1.32, P < 0.001) and were associated with a significantly higher risk of hospitalization due to stroke/SE (warfarin: HR = 2.51, 95% CI = 1.92-3.29, P < 0.001; dabigatran: HR = 2.24, 95% CI = 1.60-3.13, P < 0.001; and rivaroxaban: HR = 1.74, 95% CI = 1.31-2.30, P < 0.001). Also, the OACs were associated with significantly higher risk of hospitalization due to MB-related conditions compared with apixaban (warfarin: HR = 1.96, 95% CI = 1.71-2.23, P < 0.001; dabigatran: HR = 1.48; 95% CI = 1.25-1.76, P < 0.001; and rivaroxaban: HR = 2.17, 95% CI = 1.91-2.48, P < 0.001). Compared with apixaban, warfarin ($3,747 vs. $3,061, P < 0.001); dabigatran ($3,230 vs. $2,951, P < 0.001); and rivaroxaban ($3,950 vs. $3,060, P < 0.001) had significantly higher all-cause total health care costs per patient per month. Patients initiating the OACs also had significantly higher stroke/SE- and MB-related medical costs compared with apixaban: warfarin (stroke/SE = $135 vs. $60, P = 0.001; MB = $537 vs. $286, P < 0.001); dabigatran (stroke/SE = $94 vs. $62, P = 0.045; MB = $373 vs. $277, P = 0.010); and rivaroxaban (stroke/SE = $91 vs. $60, P = 0.008; MB = $524 vs. $287, P < 0.001). CONCLUSIONS: This real-world study showed that among elderly NVAF patients in the Medicare population, apixaban was associated with significantly lower risks of all-cause, stroke/SE-related, and MB-related hospitalizations compared with warfarin, dabigatran, and rivaroxaban. Accordingly, apixaban showed significantly lower all-cause health care costs and stroke/SE- and MB-related medical costs. DISCLOSURES: This study was funded by Bristol-Myers Squibb and Pfizer. Amin is an employee of the University of California, Irvine, and was a paid consultant to Bristol-Myers Squibb in connection with this study and the development of this manuscript. Keshishian and Zhang are employees of STATinMED Research, a paid consultant to Pfizer and Bristol-Myers Squibb in connection with this study and the development of this manuscript. Trocio, Dina, Mardekian, and Liu are employees of Pfizer, with ownership of stocks in Pfizer. Le, Rosenblatt, Nadkarni, and Vo are employees of Bristol-Myers Squibb. Rosenblatt and Vo have ownership of stocks in Bristol-Myers Squibb. Baser has no conflicts to disclose.

Published
2018

14. Comparative effectiveness of single versus multiple tablet antiretroviral therapy regimens in clinical HIV practice

Author

Drozd, Daniel R, Saag, Michael S, Westfall, Andrew O, Mathews, William Chris, Haubrich, Richard, Boswell, Stephen L, Cole, Stephen R, Porter, Donna, Kitahata, Mari M, Juday, Timothy, and Rosenblatt, Lisa

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, HIV/AIDS, Comparative Effectiveness Research, Prevention, Adult, Anti-Retroviral Agents, Female, HIV Infections, Humans, Male, Middle Aged, Treatment Outcome, ART, atripla, comparative effectiveness, HIV, single tablet regimen, CFAR Network of Integrated Clinical Systems
Abstract

We determined risk of virologic failure (VF) in individuals initiating tenofovir/emtricitabine/efavirenz as single versus multiple tablet regimens (MTR). We found no significant difference in the risk of VF, though did observe a trend toward more VF and M184 V mutations among persons initiating MTR. Temporal trends in care may have confounded results.

Published
2017

22. Assessing treatment preferences among patients with advanced/metastatic renal cell carcinoma in the United States: A discrete choice experiment.

Author

Ornstein, Moshe Chaim, primary, Rosenblatt, Lisa, additional, Ejzykowicz, Flavia, additional, Guttenplan, Sarah, additional, Del Tejo, Viviana, additional, Yin, Xin, additional, Beusterien, Kathleen M., additional, Mackie, deMauri S, additional, Will, Oliver, additional, Skiles, Grace, additional, DeCongelio, Marc, additional, and Senglaub, Steven S., additional

Published
2023
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28. Risk Levels and Adverse Clinical Outcomes Among Patients With Nonvalvular Atrial Fibrillation Receiving Oral Anticoagulants

Author

Lip, Gregory Y. H., Murphy, Richard R., Sahiar, Farhad, Ingall, Timothy J., Dhamane, Amol D., Ferri, Mauricio, Hlavacek, Patrick, Preib, Madison T., Keshishian, Allison, Russ, Cristina, Rosenblatt, Lisa, Yuce, Huseyin, and Deitelzweig, Steven

Subjects
Adult, Male, Thromboembolism/epidemiology, Embolism/epidemiology, Embolism, Anticoagulants, Hemorrhage, General Medicine, Stroke/epidemiology, Stroke, Cohort Studies, Thromboembolism, Hemorrhage/chemically induced, Atrial Fibrillation, Humans, Female, Anticoagulants/adverse effects, Atrial Fibrillation/complications, Aged, Retrospective Studies
Abstract

Importance: The CHA2DS2-VASc score (calculated as congestive heart failure, hypertension, age 75 years and older, diabetes, stroke or TIA, vascular disease, age 65 to 74 years, and sex category) is the standard for assessing risk of stroke and systemic embolism and includes age and thromboembolic history. To our knowledge, no studies have comprehensively evaluated safety and effectiveness outcomes among patients with nonvalvular atrial fibrillation receiving oral anticoagulants according to independent, categorical risk strata.Objective: To evaluate the incidence of key adverse outcomes among patients with nonvalvular atrial fibrillation receiving oral anticoagulants by CHA2DS2-VASc risk score range, thromboembolic event history, and age group.Design, Setting, and Participants: This cohort study was a retrospective claims data analysis using combined data sets from 5 large health claims databases. Eligible participants were adult patients with nonvalvular atrial fibrillation who initiated oral anticoagulants. Data were analyzed between January 2012 and June 2019.Exposure: Initiation of oral anticoagulants.Main Outcomes and Measures: We observed clinical outcomes (including stroke or systemic embolism, major bleeding, and a composite outcome) on treatment through study end, censoring for discontinuation of oral anticoagulants, death, and insurance disenrollment. The population was stratified by CHA2DS2-VASc risk score; history of stroke, systemic embolism, or transient ischemic attack; and age groups. We calculated time to event, incidence rates, and cumulative incidence for outcomes.Results: We identified 1 141 097 patients with nonvalvular atrial fibrillation; the mean (SD) age was 75.0 (10.5) years, 608 127 patients (53.3%) were men, and over 1 million were placed in the 2 highest risk categories (high risk 1, 327 766 participants; high risk 2, 688 449 participants). Deyo-Charlson Comorbidity Index scores ranged progressively alongside CHA2DS2-VASc risk score strata (mean [SD] scores: low risk, 0.4 [1.0]; high risk 2, 4.1 [2.9]). The crude incidence of stroke and systemic embolism generally progressed alongside risk score strata (low risk, 0.25 events per 100 person-years [95% CI, 0.18-0.34 events]; high risk 2, 3.43 events per 100 person-years [95% CI, 3.06-4.20 events]); patients at the second-highest risk strata with thromboembolic event history had higher stroke incidence vs patients at the highest risk score strata without event history (2.06 events per 100 person-years [95% CI, 2.00-3.12 events] vs 1.18 events per 100 person-years [95% CI, 1.14-1.30 events]). Major bleeding and composite incidence also increased progressively alongside risk score strata (major bleeding: low risk, 0.68 events per 100 person-years [95% CI, 0.56-0.82 events]; high risk 2, 6.29 events per 100 person-years [95% CI, 6.21-6.62 events]; composite incidence: 1.22 events per 100 person-years [95% CI, 1.06-1.41 events]; high risk 2, 10.67 events per 100 person-years [95% CI, 10.26-11.48 events]). The 12-month cumulative incidence proportions for stroke and systemic embolism, major bleeding, and composite outcomes progressed alongside risk score strata (stroke or systemic embolism, 0.30%-1.85%; major bleeding, 0.55%-5.55%; composite, 1.05%-8.23%). Age subgroup analysis followed similar trends.Conclusions and Relevance: The observed incidence of stroke or systemic embolism and major bleeding events generally conformed to an expected increasing incidence by risk score, adding insight into the importance of specific risk score range, thromboembolic event history, and age group strata. These results can help inform clinical decision-making, research, and policy.

Published
2022

29. Risk Levels and Adverse Clinical Outcomes Among Patients With Nonvalvular Atrial Fibrillation Receiving Oral Anticoagulants

Author

Lip, Gregory Y. H., primary, Murphy, Richard R., additional, Sahiar, Farhad, additional, Ingall, Timothy J., additional, Dhamane, Amol D., additional, Ferri, Mauricio, additional, Hlavacek, Patrick, additional, Preib, Madison T., additional, Keshishian, Allison, additional, Russ, Cristina, additional, Rosenblatt, Lisa, additional, Yuce, Huseyin, additional, and Deitelzweig, Steven, additional

Published
2022
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31. Risk of stroke/systemic embolism, major bleeding, and associated costs in non-valvular atrial fibrillation patients who initiated apixaban, dabigatran, or rivaroxaban compared with warfarin in the United States medicare population: updated analysis

Author

Amin, Alpesh, primary, Keshishian, Allison, additional, Hines, Dionne M., additional, Dina, Oluwaseyi, additional, Le, Hannah, additional, Rosenblatt, Lisa, additional, Liu, Xianchen, additional, Zhang, Qisu, additional, and Vo, Lien, additional

Published
2022
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40. Abstract 11180: Contemporary Evidence on Risk Stratification of Anticoagulated Non-Valvular Atrial Fibrillation Patients Grouped by Cha 2 D 2 -vasc Score Levels

Author

Lip, Gregory Y, primary, Murphy, Richard, additional, Sahiar, Farhad, additional, Dhamane, Amol, additional, Ferri, Mauricio, additional, Hlavacek, Patrick, additional, Preib, Madison, additional, Keshishian, Allison, additional, Russ, Cristina, additional, Rosenblatt, Lisa, additional, and Deitelzweig, Steve, additional

Published
2021
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41. Discordance between Treatment Guideline Recommendations and Real-World Practice in a Group of Large Integrated Delivery Networks for Venous Thromboembolism (VTE) Patients: A Closer Look at VTE Patients with Cancer

Author

Lotya, Juzer, primary, Dhamane, Amol, additional, Rosenblatt, Lisa, additional, Jiang, Jenny, additional, Levin, Deysia, additional, Gemmen, Eric, additional, Waugh, Sara, additional, Guo, Jennifer D, additional, Khatib, Rasha, additional, Shah, Vinay, additional, Dorsch, Michael, additional, and Luo, Xuemei, additional

Published
2021
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43. sj-docx-1-tag-10.1177_1756284821997352 – Supplemental material for Burden of major gastrointestinal bleeding among oral anticoagulant-treated non-valvular atrial fibrillation patients

Author

Deitelzweig, Steven, Keshishian, Allison, Amiee Kang, Amol D. Dhamane, Xuemei Luo, Neeraja Balachander, Rosenblatt, Lisa, Mardekian, Jack, Jiang, Jenny, Huseyin Yuce, and Lip, Gregory Y. H.

Subjects
FOS: Clinical medicine, 111199 Nutrition and Dietetics not elsewhere classified, FOS: Health sciences, 111599 Pharmacology and Pharmaceutical Sciences not elsewhere classified, 111299 Oncology and Carcinogenesis not elsewhere classified
Abstract

Supplemental material, sj-docx-1-tag-10.1177_1756284821997352 for Burden of major gastrointestinal bleeding among oral anticoagulant-treated non-valvular atrial fibrillation patients by Steven Deitelzweig, Allison Keshishian, Amiee Kang, Amol D. Dhamane, Xuemei Luo, Neeraja Balachander, Lisa Rosenblatt, Jack Mardekian, Jenny Jiang, Huseyin Yuce and Gregory Y. H. Lip in Therapeutic Advances in Gastroenterology

Published
2021
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45. Safety and effectiveness of apixaban compared with warfarin among clinically-relevant subgroups of venous thromboembolism patients in the United States Medicare population

Author

Guo, Jennifer D., primary, Hlavacek, Patrick, additional, Rosenblatt, Lisa, additional, Keshishian, Allison, additional, Russ, Cristina, additional, Mardekian, Jack, additional, Ferri, Mauricio, additional, Poretta, Tayla, additional, Yuce, Huseyin, additional, and McBane, Robert, additional

Published
2021
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48. Utilization of anticoagulants and predictors of treatment among hospitalized patients with atrial fibrillation in the USA

Author

Deitelzweig, Steven, Amol D. Dhamane, Di Fusco, Manuela, Russ, Cristina, Rosenblatt, Lisa, Lingohr-Smith, Melissa, and Lin, Jay

Abstract

To evaluate utilization of anticoagulants (ACs) and the predictors of treatment of patients with a diagnosis of atrial fibrillation (AF) during a hospital stay in the USA. Patients (≥18 years of age) who had a primary or secondary discharge diagnosis code of AF during a hospitalization (without a diagnosis of venous thromboembolism) were identified from the Premier Hospital database (1 January 2016–30 September 2017). AC treatments were examined during hospitalizations to assign AF patients into 3 study cohorts: those who received an oral AC (OAC), those who received parenteral AC only, and those who did not receive AC therapy. Multivariable logistic regression analyses were carried out to evaluate potential predictors of receiving parenteral AC only vs. OAC therapy, no AC therapy vs. OAC therapy, as well as the specific OAC drug choices. Of the patients hospitalized with an AF diagnosis (n = 482,729; mean age: 74.7 years; 46.8% female; 82.9% White; 79.4% with Medicare), 42.6% received OAC therapy (most commonly, warfarin or apixaban), 35.3% parenteral AC only, and 22.2% no AC therapy. A key predictor of not receiving OAC therapy was having an AF diagnosis in the second position (applicable to 87.4% of study population). Greater comorbidity level and prior baseline bleeding were strong predictors of receiving parenteral AC only or not receiving any AC therapy vs. receiving OAC therapy. Predictors of receiving warfarin vs. apixaban included higher stroke risk and prior baseline bleeding. OAC utilization may have been underestimated since outpatient OAC utilization was not included in the analysis. A substantial portion of hospitalized AF patients did not receive any AC therapy, particularly those patients with an AF diagnosis in the second position on hospital records. The predictors of inpatient AC treatment that were identified may be helpful in the clinical decision-making process for patients who are hospitalized with AF.

Published
2020
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50. Effectiveness and Safety of Apixaban, Low-Molecular-Weight Heparin, and Warfarin among Venous Thromboembolism Patients with Active Cancer: A U.S. Claims Data Analysis

Author

Cohen, Alexander, additional, Keshishian, Allison, additional, Lee, Theodore, additional, Wygant, Gail, additional, Rosenblatt, Lisa, additional, Hlavacek, Patrick, additional, Mardekian, Jack, additional, Wiederkehr, Daniel, additional, Sah, Janvi, additional, and Luo, Xuemei, additional

Published
2020
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