Cost comparison of continued anticoagulation with rivaroxaban versus placebo based on the 1-year EINSTEIN-Extension trial efficacy and safety results

Wells, Phillip S.; Lensing, Anthonie W. A.; Haskell, Lloyd; Levitan, Bennett; Laliberté, François; Durkin, Mike; Ashton, Veronica; Xiao, Yongling; Crivera, Concetta; Lejeune, Dominique; Schein, Jeff; Lefèbvre, Patrick

doi:10.1080/13696998.2018.1444615

Cited by 2 publications

(2 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although CRNMB lacks the devastating clinical effects of MB, it is associated with a decreased quality of life, 5 , 6 hospital admissions, 47 interventions, 48 and costs of care. 4 In our study, approximately twice as many patients experienced CRNMB than MB, with 15% of outpatients requiring hospital admission and 11% of patients requiring surgical hemostasis. A high risk of falls was associated with a 2-fold increased risk of CRNMB.…”

Section: Discussionmentioning

confidence: 52%

“…2 , 3 The most serious manifestations of anticoagulation-related bleeding include fatal and intracranial bleeding, which accounts for 13.4% and 8.7% of MBs, respectively. 3 Anticoagulation-related MB also is associated with substantial health care costs 4 and a reduction of quality of life. 5 , 6 Prior studies have shown that the incidence of anticoagulation-related bleeding risk is not linear, with a higher risk of MB in the early phase than during subsequent anticoagulation periods.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence and clinical impact of bleeding events in older patients with acute venous thromboembolism

et al. 2023

View full text Add to dashboard Cite

Elderly patients anticoagulated for venous thromboembolism (VTE) have an increased risk of bleeding compared to younger patients. Little is known about the clinical impact of anticoagulation-related bleeding in this growing patient group. To prospectively assess the incidence, clinical impact, and predictors of bleeding in elderly patients anticoagulated for VTE. We analyzed 981 patients aged ≥65 years with acute VTE in a prospective multicenter cohort. 88% were anticoagulated with vitamin K antagonists. Outcomes were the occurrence of a major (MB) or clinically relevant non-major bleeding (CRNMB) during the initial anticoagulation period up to 36 months. We described the incidence and clinical impact of bleeding and examined the association between risk factors and time to a first bleeding using competing risk regression. 100 MB and 125 CRNMB occurred during follow-up. The incidence of MB and CRNMB was 8.5 (95%CI 7.0-10.4) and 13.4 events (95%CI 11.4-15.7) per 100 patient-years, respectively. In patients with MB, 79% required hospitalization, 18% a surgical intervention, and 19% a permanent discontinuation of anticoagulation. 15% of MB were intracranial and 6% fatal. After adjustment, active cancer (sub-hazard ratio [SHR] 1.81, 95%CI 1.12-2.93) and low physical activity (SHR 1.88, 95%CI 1.19-2.98) were associated with MB, and high risk of falls with CRNMB (SHR 2.04, 95%CI 1.39-3.00). Older patients anticoagulated for VTE had a high incidence of MB and CRNMB, and these bleeding episodes caused a great burden of disease. Physicians should carefully weigh the risks/benefits of extended anticoagulation in the older population with VTE.

show abstract

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Incidence and clinical impact of bleeding events in older patients with acute venous thromboembolism

et al. 2023

View full text Add to dashboard Cite

show abstract

Extended anticoagulation for the secondary prevention of venous thromboembolic events: An updated network meta-analysis

Mai¹,

Bertoletti²,

Cucherat³

et al. 2019

PLoS ONE

View full text Add to dashboard Cite

Background Extended treatment is preconized in a significant proportion of patients with unprovoked venous thromboembolism (VTE). However, limited direct/indirect comparisons are available to appropriately weight the benefit/risk ratio of the diverse treatments available. We aimed to compare the rate of symptomatic recurrent VTE and major bleeding (MB), the net clinical benefit (VTE+MB) and death on vitamin-K antagonist (VKA), direct oral anticoagulants (DOAC) and antiplatelet drugs for extended anticoagulation. Methods A systematic literature search through September 2018 identified randomized trials studying these pharmacologic therapies for extended anticoagulation following VTE. Treatment effects were calculated using network meta-analysis with frequentist fixed-effects model. Results 18 trials (18,221 patients) were included in the analysis. All treatments reduced the risk of recurrence compared to placebo/observation. Nonetheless, VKA (RR 0.22; 95%CI 0.13–0.39) and DOAC (RRs ranging from 0.25–0.32; 95%CI ranging from 0.13–0.52) were more effective than aspirin, whereas low-dose VKA was less effective than standard-dose VKA (RR 2.47; 95%CI 1.34–4.55). The efficacy of DOAC was globally comparable to standard-adjusted dose VKA. Low- (RR 3.13; 95%CI 1.37–7.16) and standard-dose (RR 3.23; 95%CI 1.16–8.99) VKA also increased the risk of MB, which was not the case for any DOAC. Low-dose VKA and low-dose DOAC had similar effects on MB compared to standard-doses. Although there was a trend for reduced MB and enhanced net clinical benefit for DOAC compared to VKA, this was not statistically significant. The specific anticoagulant therapies had no significant effects on deaths. Conclusion Standard-dose VKA and low/standard-dose DOAC share similar effects on VTE recurrence and MB, whereas aspirin and low-dose VKA were associated with lower benefit/risk ratio.

show abstract

Cost comparison of continued anticoagulation with rivaroxaban versus placebo based on the 1-year EINSTEIN-Extension trial efficacy and safety results

Abstract: Total healthcare costs were estimated to be lower for patients continuing rivaroxaban therapy compared to those receiving placebo in VTE patients who had completed 6-12 months of VTE treatment.

Cited by 2 publications

References 26 publications

Incidence and clinical impact of bleeding events in older patients with acute venous thromboembolism

Incidence and clinical impact of bleeding events in older patients with acute venous thromboembolism

Extended anticoagulation for the secondary prevention of venous thromboembolic events: An updated network meta-analysis

Contact Info

Product

Resources

About