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Abstract The comparative effectiveness and safety of oral anticoagulant therapies to prevent a second recurrent venous thromboembolism (VTE) remains undetermined. We aimed to compare the benefits and harms of direct oral anticoagulant (DOAC) and warfarin therapies in preventing second recurrent VTE and major bleeding events among patients with a recurrent VTE episode following anticoagulation therapy for incident VTE. A retrospective cohort analysis of two large national insurance claims databases was conducted for patients with two episodes of VTE. Cox proportional hazards models were used after inverse probability treatment weighting to compare risks of second recurrent VTE and major bleeding events. Compared with warfarin, DOAC therapy was associated with significantly decreased risk of second recurrent VTE with no significant difference in risk of major bleeding events. Our findings suggest that, compared with warfarin, DOACs may reduce risk of second VTE recurrence among patients who have experienced one recurrence.

Abstract Guidelines recommend an extended course of anticoagulation therapy for patients who experienced venous thromboembolism (VTE) without transient provocation, however, optimal duration remains uncertain. We assessed effectiveness and safety of extended use of apixaban and warfarin greater than 6 months of initial treatment in patients with VTE. We conducted a retrospective cohort study of Medicare beneficiaries aged greater than or equal to 18 years with deep vein thrombosis or pulmonary embolism. Patients were required to have initiated anticoagulants within 30 days of their first VTE diagnosis, completed 6 months of initial anticoagulant treatment, and received extended phase treatment with apixaban (the apixaban group) or warfarin (the warfarin group) or no extended therapy. Multivariable Cox proportional hazards modeling with inverse probability treatment weighting was used to compare recurrent VTE, mortality, and major bleeding risks among the three groups. Mean extended‐treatment duration was up to 10 months and 14 months in apixaban and warfarin groups, respectively. Compared with no extended treatment, apixaban use was associated with decreased risks of recurrent VTE (hazard ratio [HR] = 0.08, [95% confidence interval [CI]: 0.01–0.41]) and mortality (HR = 0.37, [95% CI: 0.27–0.51]) without increased major bleeding risk (HR = 1.29, [95% CI: 0.68–2.45]); warfarin use was associated not with recurrent VTE risk change but with increased major bleeding risk (HR = 2.14, [95% CI: 1.26–3.65]) and decreased mortality risk (HR = 0.39, [95% CI: 0.29–0.51]). Compared with warfarin, apixaban use was associated with decreased recurrent VTE (HR = 0.13, [95% CI: 0.03–0.63]) and major bleeding (HR = 0.56, [95% CI: 0.32–0.98]) risks. Subgroup and sensitivity analyses (e.g., intention‐to‐treat) findings remained consistent. Compared with warfarin or no extended therapy, extended‐apixaban use was associated with reduced risk of recurrent VTE without increased major bleeding risk. Continuing anticoagulant therapy with apixaban greater than 6 months may be effective and safe.

Study objective: Half of patients with heart failure have preserved ejection fraction (HFpEF). Over the years, guidelines have recommended or advised against various therapies for HFpEF management. However, there is limited evidence on the trends in utilization of the various medications. The aim of this study was to examine the trends in the use of pharmacotherapies among patients with HFpEF from 2008 through 2020. Design: Retrospective cohort study of patients with HFpEF used MarketScan® Commercial and Medicare Supplemental Databases (2007–2020). Participants: Patients with HFpEF. Outcome measures: Utilization rates for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), aldosterone receptor antagonists (ARAs), diuretics, β-blockers, calcium channel blockers (CCBs), phosphodiesterase 5 inhibitors (PDE5Is), nitrates, digoxin, and sodium glucose cotransporter-2 inhibitors (SGLT2i) within 90 days of the first HFpEF diagnosis. Results: We identified 156,730 patients with HFpEF (mean [SD] age, 73 [13.4] years; 57 % females). From 2008 to 2020, we found increased utilization rates for ARNIs (0.02 % vs. 0.17 % of all patients, p

Patients receiving chronic warfarin therapy for secondary venous thromboembolism (VTE) prevention often require therapeutic interruptions surrounding planned surgical procedures to mitigate the risk of hemorrhagic complications. For patients at moderate to high risk of recurrent VTE short-acting subcutaneous anticoagulants, such as low molecular weight heparins, can be utilized as a warfarin bridge to reduce the risk of periprocedural VTE. Although the efficacy of the direct oral acting anticoagulants (DOACs) for the treatment and prevention of VTE has been well established these agents have not been studied as a periprocedural bridge in patients requiring planned interruptions in warfarin therapy. We report the case of a patient required to interrupt her warfarin therapy for a procedure who highly desired VTE risk mitigation but was unwilling to utilize a subcutaneous anticoagulant. Apixaban was successfully used in place of the subcutaneous anticoagulant as a bridge during the patient's planned warfarin interruption. In the 90 days following the bridge the patient did not experience any hemorrhagic or VTE related complications.

Background: Ambulatory blood pressure monitoring (ABPM) has been increasingly recommended for diagnosis confirmation and monitoring in patients with new-onset hypertension and apparent treatment-resistant hypertension (aTRH). We assessed insurance claims submitted for ABPM among a nationally representative sample of commercially insured U.S. patients. Methods: We conducted a retrospective cross-sectional analysis using the IBM MarketScan® commercial claims database from January 2008–December 2017, including 2 populations: those with incident treated hypertension (ITH; first antihypertensive filled) or aTRH (first overlapping use of 4 antihypertensive agents). We identified ABPM claims filed within 6 months before to 6 months after the qualifying antihypertensive fill and determined prevalence of ABPM use overall and by year in each population. Results: In total, 2,820,303 patients met ITH criteria and 298,049 met aTRH criteria. Of those with ITH, 7650 (2.7 per 1000 persons) had ≥1 ABPM claim submitted, and annual ABPM prevalence ranged from 2.0 to 3.7 per 1000 persons, increasing over time (Ptrend