Safety, effectiveness, and health care cost comparisons among elderly patients with venous thromboembolism prescribed warfarin or apixaban in the United States Medicare population

<p>Platelet Count and Bleeding in Patients Receiving Anticoagulant Therapy for Venous Thromboembolism: Lesson from the RIETE Registry</p>

“…The incidence of bleeding associated with therapeutic doses of unfractionated heparin, low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs) is around 10-17% per year for all events, 2-5% per year for major bleeding, and 0.5-1% per year for fatal bleeding. 3 The reported annual occurrence of intracranial bleeding, which represents the most feared bleeding complication because of its high disability and fatality rate, is in the range of 0.2-0.4%. [4][5][6] Stratification of the individual risk of bleeding prior to initiation of therapy in patients with acute VTE has the potential to assist clinicians in making decisions about the proper intensity and duration of anticoagulant therapy.…”

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

“…Subgroups included index VTE encounter type, index VTE diagnosis type, index VTE etiology, sex, and frailty. Previously published results showed that after applying PSM to the overall study population, patients prescribed warfarin were associated with a significantly higher risk of MB and CRNM bleeding and a similar risk of recurrent VTE, as compared with those prescribed apixaban [17]. No significant interactions were observed between treatment and index VTE encounter type, index VTE diagnosis type, or sex.…”

“…In the AMPLIFY trial, apixaban use was associated with a lower risk of MB (0.6% vs 1.8%; relative risk = 0.31 [0.17-0.55]) and CRNM bleeding (3.8% vs 8.0%; relative risk = 0.48 [0.38-0.60]) as compared with conventional therapy (enoxaparin followed by warfarin) over a six month period. The risk of recurrent VTE or VTE-related death during follow-up was similar among patients initiating apixaban as compared with conventional therapy initiators (2.3% vs 2.7%; relative risk = 0.84 [0.60-1.18]) [14][15][16][17]. A recently published real-world study using a commercial and Medicare supplemental database as well as another study that pooled 4 commercial databases also found that apixaban use was associated with significantly lower risks of MB and recurrent VTE as compared with warfarin use [15,32].…”

“…Patients with VTE were identified by a medical claim including a primary or secondary VTE diagnosis in the inpatient or ambulatory setting (including emergency room) during the identification period from September 1, 2014 through December 31, 2016; the first VTE event was designated as the index VTE encounter. Additional details about the study population selection and results can be found in a prior publication [17]. In summary, patients aged ≥65 years were selected if prescribed apixaban or warfarin within 30 days following the index VTE encounter, and the first apixaban or warfarin prescription date was designated as the index date.…”

“…The present study authors previously undertook a real-world study among the Medicare population to compare apixaban and warfarin regarding the economic and clinical burden associated with VTE and bleeding in elderly patients. The results showed that compared with apixaban, warfarin was associated with significantly higher risks of MB and CRNM, and significantly higher MB-related and total health care costs [17]. However, the primary focus of that study was exploration of economic outcomes.…”