National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (11)
- Adverse Events (10)
- Blood Clots (3)
- (-) Blood Thinners (33)
- (-) Cardiovascular Conditions (33)
- Care Management (2)
- Chronic Conditions (2)
- Clinician-Patient Communication (1)
- Communication (1)
- Comparative Effectiveness (5)
- COVID-19 (2)
- Decision Making (2)
- Elderly (4)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (9)
- Guidelines (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (1)
- Heart Disease and Health (24)
- Hospitalization (1)
- Inpatient Care (1)
- Kidney Disease and Health (2)
- Medical Errors (1)
- Medicare (1)
- Medication (31)
- Medication: Safety (6)
- Outcomes (9)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (9)
- Patient Adherence/Compliance (1)
- Patient Safety (5)
- Practice Patterns (2)
- Prevention (2)
- Registries (4)
- Research Methodologies (1)
- Risk (5)
- Sex Factors (1)
- Social Determinants of Health (1)
- Stroke (8)
- Surgery (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 33 Research Studies DisplayedTroy AL, Herzig SJ, Trivedi S
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
This study investigated prevalence of oral anticoagulant initiation for newly diagnosed US older adults with atrial fibrillation within 7 days of hospital discharge. The authors used a 20% national sample of Medicare fee-for-service beneficiaries, identifying patients aged 65 years or older newly diagnosed with atrial fibrillation while hospitalized in 2016. Among 38,379 older adults newly diagnosed with atrial fibrillation while hospitalized (mean age 78.2; 51.8% female; 83.3% white), 36,633 (95.4%) had an indication for anticoagulation and 24.6% (9011) of those initiated an oral anticoagulant following discharge. Higher CHA(2) DS(2) -VASc score was associated with a small increase in oral anticoagulant initiation (predicted probability 20.5% for scores <2 and 24.9% for ≥4). Elevated HAS-BLED score was associated with a small decrease in probability of anticoagulant initiation (25.4% for score <2 and 23.1% for ≥3). Frailty was associated with decreased likelihood of oral anticoagulant initiation (24.7% for non-frail and 18.1% for moderately-severely frail). Anticoagulant initiation varied by primary reason for hospitalization, with predicted probability highest among patients with a primary diagnosis of atrial fibrillation (46.1%) and lowest among those with non-cardiovascular conditions (13.8%) and bleeds (3.6%).
AHRQ-funded; HS026215.
Citation: Troy AL, Herzig SJ, Trivedi S .
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
J Am Geriatr Soc 2023 Sep; 71(9):2748-58. doi: 10.1111/jgs.18375..
Keywords: Elderly, Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Stroke
Derington CG, Goodrich GK, Xu S
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
This study investigated the impact of an anticoagulation management service (AMS) on clinical outcomes of adults with atrial fibrillation (AF). This retrospective cohort study was conducted in 3 Kaiser Permanente regions, with each region taking a slightly different approach to direct oral anticoagulant (DOAC) care. These approaches included (1) usual care (UC) by the prescribing clinician, (2) UC plus an automated population management tool (PMT), or (3) pharmacist-managed AMS care. The study included 44,746 adults with a diagnosis of AF who initiated DOAC or warfarin between August 2016 and January 1, 2020, 6182 in the UC model, 33,624 in the UC plus PMT care model, and 4939 in the AMS care model. Baseline characteristics (mean age, 73.1 years, 56.1% male, 67.2% non-Hispanic White, median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female sex] score of 3 [IQR, 2-5]) were well balanced after inverse probability of treatment weighting (IPTW). The cohort was followed over a median of 2 years, and patients who received the UC plus PMT or AMS care model did not have significantly better outcomes than those who received only UC.
AHRQ-funded; HS026156.
Citation: Derington CG, Goodrich GK, Xu S .
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
JAMA Netw Open 2023 Jul; 6(7):e2321971. doi: 10.1001/jamanetworkopen.2023.21971..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Outcomes, Stroke
Marcaccio CL, Patel PB, Rastogi V
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
This study’s objective was to examine the efficacy and safety of preoperative single antiplatelet therapy (AP) therapy vs double antiplatelet therapy (DAPT) in patients who had undergone transfemoral CAS (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who had undergone tfCAS or TCAR in the Vascular Quality Initiative database from 2016 to 2021. A total of 18,570 tfCAS patients were included, of which 70% had received DAPT, 5.6% no AP therapy, 10% ASA only, 8.0% ASA + AP loading dose, 4.6% P2Y12 inhibitor (P2Yi) only, and 2.9% P2Yi + AP loading dose. After adjustment, compared with DAPT, the incidence of stroke/death was higher with no AP therapy, ASA only, and ASA + AP loading dose, but was similar with P2Yi only, and P2Yi + AP loading dose. No differences were found in the incidence of bleeding rates between the treatment groups after tfCAS or TCAR. These findings support the current guidelines recommending DAPT before CAS but also suggest that P2Yi monotherapy might confer thromboembolic benefits similar to those with DAPT.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Rastogi V .
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
J Vasc Surg 2023 May; 77(5):1434-46.e11. doi: 10.1016/j.jvs.2022.12.034..
Keywords: Blood Thinners, Medication, Medication: Safety, Cardiovascular Conditions, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Gamyroulas EM, Jones AE, Saunders JA
Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients.
The guidelines for antithrombotic management in individuals undergoing percutaneous coronary interventions (PCIs) who also necessitate anticoagulant treatment are continually developing. The purpose of this study is to examine adjustments to antithrombotic regimens and correlated outcomes within a year following PCI in patients needing continued anticoagulation therapy. Data from patients discovered through electronic medical record searches were manually assessed to validate alterations in antithrombotic treatment from discharge up to one year post-PCI, as well as episodes of significant bleeding, clinically relevant non-major bleeding (CRNMB), major adverse cardiovascular or neurological events (MACNE), and all-cause mortality outcomes during an extra six-month follow-up period. The study found that one year after PCI, patients (n = 120) undergoing anticoagulation treatment were categorized based on their antiplatelet therapy status: no antiplatelet therapy (n = 16), single antiplatelet therapy (SAPT) (n = 85), or dual antiplatelet therapy (DAPT) (n = 19). Between 12 and 18 months post-PCI, there were two significant bleeds, seven CRNMB events, six MACNE incidents, two venous thromboembolisms, and five fatalities. All but one bleeding occurrence transpired in the SAPT group. The likelihood of maintaining DAPT at 12 months was elevated in patients who underwent PCI for acute coronary syndrome and those who experienced MACNE within one year post-PCI; however, these associations did not reach statistical significance.
AHRQ-funded; HS027960
Citation: Gamyroulas EM, Jones AE, Saunders JA .
Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients.
BMC Cardiovasc Disord 2023 Mar 8;23(1):117. doi: 10.1186/s12872-023-03161-7.
Keywords: Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Adverse Drug Events (ADE), Adverse Events
Kravchenko OV, Boyce RD, Gomez-Lumbreras A
Drug-drug interaction between dexamethasone and direct-acting oral anticoagulants: a nested case-control study in the national COVID cohort collaborative (N3C).
This study examined whether there is an association between thromboembolotic events (TEEs) and concomitant use of dexamethasone with either apixaban or rivaroxaban (both direct oral anticoagulants or DOACs) during treatment for COVID-19. The authors used data from the National COVID Cohort Collaborative (N3C) to conduct a nested case-control study. Eligible participants were adults over 18 years who were exposed to a DOAC for 10 or more consecutive days and exposure to dexamethasone at least 5 or more consecutive days. The study did not find a discernible association of TEE in patients concomitantly exposed to dexamethasone and a DOAC.
AHRQ-funded; HS025984.
Citation: Kravchenko OV, Boyce RD, Gomez-Lumbreras A .
Drug-drug interaction between dexamethasone and direct-acting oral anticoagulants: a nested case-control study in the national COVID cohort collaborative (N3C).
BMJ Open 2022 Dec 29; 12(12):e066846. doi: 10.1136/bmjopen-2022-066846..
Keywords: COVID-19, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Cardiovascular Conditions, Medication: Safety, Patient Safety
Meng T, Trickey AM, Harris AHS
Lessons learned from the historical trends on thrombolysis use for acute ischemic stroke among Medicare beneficiaries in the United States.
The authors’ objectives were to assess and validate the change in intravenous thrombolysis (IVT) utilization in a national sample of Medicare beneficiaries and to examine the effect of patient, stroke center designation, and geography on IVT utilization. They found that, between 2007 and 2014, the frequency of IVT for patients with acute ischemic stroke increased substantially, though differences persisted in the form of less frequent treatment associated with certain characteristics.
AHRQ-funded; HS026207.
Citation: Meng T, Trickey AM, Harris AHS .
Lessons learned from the historical trends on thrombolysis use for acute ischemic stroke among Medicare beneficiaries in the United States.
Front Neurol 2022 Mar 4;13:827965. doi: 10.3389/fneur.2022.827965..
Keywords: Stroke, Cardiovascular Conditions, Blood Thinners
Vaughn VM, Yost M, Abshire C
Trends in venous thromboembolism anticoagulation in patients hospitalized with COVID-19.
This study’s objective was to characterize frequency, variation across hospitals, and change over time in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality. This cohort study used adults hospitalized with COVID-19 from 30 pseudorandom hospitals in Michigan from March 7, 2020, to June 17, 2020. Main outcomes measured were the effect of nonadherence and anticoagulation strategies on in-hospital and 60-day mortality. Of a total 1351 patients with COVID-19 with a median age of 64 years, 47.7% women and 48.9% Black, only 18 (1.3%) had a confirmed VTE, and 219 (16.2%) received treatment-dose anticoagulation. Use of treatment-dose anticoagulation without imaging ranged from 0% to 29% across hospitals and increased over time. Of 1127 patients who ever received anticoagulation, 392 missed 2 or more days of prophylaxis. Missed prophylaxis varied from 11% to 61% across hospitals and decreased markedly over time. VTE nonadherence was associated with higher 60-day (adjusted hazard ratio [aHR], 1.31) but not in-hospital mortality (aHR, 0.97). Receiving any dose of anticoagulation (vs no anticoagulation) was associated with lower in-hospital mortality (only prophylactic dose: aHR, 0.36; any treatment dose: aHR, 0.38). However, only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose: aHR, 0.71; treatment dose: aHR, 0.92).
AHRQ-funded; HS026530.
Citation: Vaughn VM, Yost M, Abshire C .
Trends in venous thromboembolism anticoagulation in patients hospitalized with COVID-19.
JAMA Netw Open 2021 Jun 1; 4(6):e2111788. doi: 10.1001/jamanetworkopen.2021.11788..
Keywords: COVID-19, Blood Clots, Blood Thinners, Medication, Inpatient Care, Cardiovascular Conditions
Feng Y, Pai CW, Seiler K
Adverse outcomes associated with inappropriate direct oral anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study.
This retrospective analysis investigated the risk for bleeding events with higher dosing of direct oral anticoagulant (DOAC) in the first 1-3 weeks of treatment for patients with atrial fibrillation (AF). Findings showed that patients who received an inappropriate DOAC prescription were more likely to identify as Black. Rates of ED visits, hospitalizations, and deaths overall were numerically lower in patients with starter pack DOAC prescriptions. In contrast, rates of ED visits and hospitalizations related to significant bleeding were numerically higher in patients with starter pack DOAC prescriptions. Among patients with AF but without acute venous thromboembolism, 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.
AHRQ-funded; HS026874.
Citation: Feng Y, Pai CW, Seiler K .
Adverse outcomes associated with inappropriate direct oral anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study.
J Thromb Thrombolysis 2021 May;51(4):1144-49. doi: 10.1007/s11239-020-02358-3..
Keywords: Blood Thinners, Medication, Medication: Safety, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Heart Disease and Health, Cardiovascular Conditions
Rhee TG, Kumar M, Ross JS
Age-related trajectories of cardiovascular risk and use of aspirin and statin among U.S. Adults Aged 50 or older, 2011-2018.
The purpose of this study was to examine age-related trajectories of cardiovascular risk and use of aspirin and statin among U.S. adults aged 50 or older. The investigators concluded that while adults aged ≥75 do not benefit from the use of aspirin to prevent the first CVD, many continue to take aspirin on a regular basis. In spite of the clear benefit of statin use to prevent a subsequent CVD event, many older adults in this risk category are not taking a statin.
AHRQ-funded; HS022882.
Citation: Rhee TG, Kumar M, Ross JS .
Age-related trajectories of cardiovascular risk and use of aspirin and statin among U.S. Adults Aged 50 or older, 2011-2018.
J Am Geriatr Soc 2021 May;69(5):1272-82. doi: 10.1111/jgs.17038..
Keywords: Elderly, Blood Thinners, Cardiovascular Conditions, Heart Disease and Health, Risk, Medication
Barnes GD
Combining antiplatelet and anticoagulant therapy in cardiovascular disease.
The author describes results of a number of randomized clinical trials that have explored different combinations of anticoagulation plus antiplatelet agents aimed at minimizing bleeding risk while preserving low thrombotic event rates. Findings include shorter courses with fewer antithrombotic agents as being effective, particularly when direct oral anticoagulants are combined with clopidogrel. Combined use of very low-dose rivaroxaban plus aspirin also demonstrated benefit in atherosclerotic diseases, including coronary and peripheral artery disease. Use of proton pump inhibitor therapy while patients were taking multiple antithrombotic agents had the potential to further reduce upper gastrointestinal bleeding risk in select populations. The author recommends that applying this evidence to patients with multiple thrombotic conditions will help to avoid costly and life-threatening adverse medication events.
AHRQ-funded; HS026874; HS026322.
Citation: Barnes GD .
Combining antiplatelet and anticoagulant therapy in cardiovascular disease.
Hematology Am Soc Hematol Educ Program 2020 Dec 4;2020(1):642-48. doi: 10.1182/hematology.2020000151..
Keywords: Blood Thinners, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Cardiovascular Conditions
Yao X, Inselman JW, Ross JS
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Patients with atrial fibrillation and severely decreased kidney function were excluded from the pivotal non-vitamin K antagonist oral anticoagulants (NOAC) trials, thereby raising questions about comparative safety and effectiveness in patients with reduced kidney function. This study aimed to compare oral anticoagulants across the range of kidney function in patients with atrial fibrillation.
AHRQ-funded; HS025517; HS025164; HS025402; HS022882; HS024075.
Citation: Yao X, Inselman JW, Ross JS .
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Circ Cardiovasc Qual Outcomes 2020 Oct;13(10):e006515. doi: 10.1161/circoutcomes.120.006515..
Keywords: Kidney Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Medication: Safety, Patient Safety, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Jackson LR, Kim S, Blanco R
Discontinuation rates of warfarin versus direct acting oral anticoagulants in US clinical practice: results from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II).
The objective of this study was to evaluate discontinuation rates among patients on warfarin and direct oral anticoagulants (DOACs) in clinical practice. Over 10,000 AF patients were enrolled from the ORBIT-AF II Registry as subjects. Findings showed that, in a community based atrial fibrillation cohort, adjusted rates of discontinuation at 12 months were higher in DOAC-treated versus vitamin K antagonist-treated patients. Discontinuation of oral anticoagulation was associated with increased absolute risk of all-cause mortality and cardiovascular death.
AHRQ-funded; HS021092.
Citation: Jackson LR, Kim S, Blanco R .
Discontinuation rates of warfarin versus direct acting oral anticoagulants in US clinical practice: results from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II).
Am Heart J 2020 Aug;226:85-93. doi: 10.1016/j.ahj.2020.04.016..
Keywords: Blood Thinners, Medication, Registries, Stroke, Heart Disease and Health, Cardiovascular Conditions, Outcomes
Abraham NS, Yang EH, Noseworthy PA
Fewer gastrointestinal bleeds with ticagrelor and prasugrel compared with clopidogrel in patients with acute coronary syndrome following percutaneous coronary intervention.
The goal of this study was to compare gastrointestinal bleeding (GIB) rates associated with clopidogrel, prasugrel, and ticagrelor using national medical and pharmacy claims data from privately insured and Medicare Advantage enrollees. Findings showed that, in the first year following percutaneous coronary intervention for acute coronary syndrome, ticagrelor and prasugrel were associated with fewer GIB events compared with clopidogrel.
AHRQ-funded; HS025402.
Citation: Abraham NS, Yang EH, Noseworthy PA .
Fewer gastrointestinal bleeds with ticagrelor and prasugrel compared with clopidogrel in patients with acute coronary syndrome following percutaneous coronary intervention.
Aliment Pharmacol Ther 2020 Aug;52(4):646-54. doi: 10.1111/apt.15790..
Keywords: Medication: Safety, Medication, Blood Thinners, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Cardiovascular Conditions, Surgery
Pokorney SD, Black-Maier E, Hellkamp AS
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
The objective of this study was to describe patterns of oral anticoagulant (OAC) use in end-stage renal disease (ESRD) patients with atrial fibrillation (AF) and their associations with cardiovascular outcomes. Medicare fee-for-service 5% claims data from 2007 to 2013 was analyzed in a cohort of patients with ESRD and AF. A cohort of 8,410 patients with AF and ESRD was identified, with a total of 3,043 (36.2%) patients treated with OAC during the study period. Treatment with OAC was not associated with hospitalization for stroke, or death but was associated with increased hospitalization for bleeding and intracranial hemorrhage.
AHRQ-funded; HS021092.
Citation: Pokorney SD, Black-Maier E, Hellkamp AS .
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
J Am Coll Cardiol 2020 Mar 24;75(11):1299-308. doi: 10.1016/j.jacc.2020.01.019..
Keywords: Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Kidney Disease and Health, Chronic Conditions, Outcomes
Brand-McCarthy SR, Delaney RK, Noseworthy PA
Can shared decision making improve stroke prevention in atrial fibrillation?: Implications of the updated guidelines.
This paper discusses the need for shared decision making (SDM) in atrial fibrillation (AF) patients not just at the beginning of treatment but throughout during ongoing care. Use of SDM can help with patient adherence to recommended anticoagulation treatment regimens and lifestyle changes. It can help build a strong partnership between clinician and patient.
AHRQ-funded; HS026379.
Citation: Brand-McCarthy SR, Delaney RK, Noseworthy PA .
Can shared decision making improve stroke prevention in atrial fibrillation?: Implications of the updated guidelines.
Circ Cardiovasc Qual Outcomes 2020 Mar;13(3):e006080. doi: 10.1161/circoutcomes.119.006080..
Keywords: Decision Making, Stroke, Heart Disease and Health, Cardiovascular Conditions, Prevention, Guidelines, Blood Thinners, Medication, Clinician-Patient Communication, Communication
Wang SV, Rogers JR, Jin Y
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Clinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated. The purpose of this study was to evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF. The investigators concluded that algorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment.
AHRQ-funded; HS022193.
Citation: Wang SV, Rogers JR, Jin Y .
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
BMJ Qual Saf 2019 Oct;28(10):835-42. doi: 10.1136/bmjqs-2019-009367..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication, Health Information Technology (HIT), Decision Making, Electronic Health Records (EHRs), Practice Patterns, Healthcare Utilization
Mentias A, Briasoulis A, Shantha G
Impact of heart failure type on thromboembolic and bleeding risk in patients with atrial fibrillation on oral anticoagulation.
Differential impact of heart failure (HF) category on thromboembolic and bleeding risk in atrial fibrillation (AF) patients on oral anticoagulation (OAC) is unknown. In this study, the investigators used Medicare data for beneficiaries with new AF diagnosed between 2011 and 2013 to identify patients with HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and no HF. The investigators concluded that in AF patients, HFrEF and HFpEF are both associated with higher risk of ischemic stroke, HF and AMI admissions, even after adjusting for OAC use, compared with patients without HF.
AHRQ-funded; HS023104.
Citation: Mentias A, Briasoulis A, Shantha G .
Impact of heart failure type on thromboembolic and bleeding risk in patients with atrial fibrillation on oral anticoagulation.
Am J Cardiol 2019 May 15;123(10):1649-53. doi: 10.1016/j.amjcard.2019.02.027..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Elderly, Patient-Centered Healthcare, Registries
Lowenstern A, Al-Khatib SM, Sharan L
Interventions for preventing thromboembolic events in patients with atrial fibrillation: a systematic review.
The purpose of this review was to compare the effectiveness of therapies to prevent thromboembolic events and bleeding complications in adults with nonvalvular atrial fibrillation (AF). Two independent reviewers screened citations in order to identify comparative studies of treatments to prevent stroke in adults with nonvalvular AF who reported thromboembolic or bleeding complications, then abstracted data from 220 selected articles, assessed study quality and applicability, and rated the strength of evidence. The article concludes that available direct-acting oral anticoagulants (DOACs) are at least as effective and safe as warfarin for patients with nonvalvular AF and had similar benefits across several patient subgroups.
AHRQ-funded; 290201500004I.
Citation: Lowenstern A, Al-Khatib SM, Sharan L .
Interventions for preventing thromboembolic events in patients with atrial fibrillation: a systematic review.
Ann Intern Med 2018 Dec 4;169(11):774-87. doi: 10.7326/m18-1523..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Blood Thinners, Adverse Drug Events (ADE), Adverse Events, Medication, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice
Borre ED, Goode A, Raitz G
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
This systematic review compared the strength of tools to predict stroke and bleeding risk in patients with atrial fibrillation (AF) taking blood thinners. Sixty-one studies were found to predict thromboembolic risk and 38 to predict bleeding risk.
AHRQ-funded; 290201500004I.
Citation: Borre ED, Goode A, Raitz G .
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
Thromb Haemost 2018 Dec;118(12):2171-87. doi: 10.1055/s-0038-1675400..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Stroke, Blood Clots, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Patient-Centered Outcomes Research, Evidence-Based Practice
Desai RJ, Wyss R, Jin Y
Extension of disease risk score-based confounding adjustments for multiple outcomes of interest: an empirical evaluation.
Use of disease risk score (DRS)-based confounding adjustment when estimating treatment effects on multiple outcomes is not well studied. In this empirical cohort study, the investigators compared dabigatran initiators and warfarin initiators with respect to risks of ischemic stroke and major bleeding in 12 sequential monitoring periods (90 days each), using data from the Truven Marketscan database (Truven Health Analytics, Ann Arbor, Michigan).
AHRQ-funded; HS022193.
Citation: Desai RJ, Wyss R, Jin Y .
Extension of disease risk score-based confounding adjustments for multiple outcomes of interest: an empirical evaluation.
Am J Epidemiol 2018 Nov;187(11):2439-48. doi: 10.1093/aje/kwy130.
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Keywords: Blood Thinners, Cardiovascular Conditions, Medication, Outcomes, Research Methodologies, Risk, Stroke
Mentias A, Shantha G, Chaudhury P
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
The purpose of this retrospective comparative effectiveness analysis was to determine whether there are differences in efficacy and safety of dabigatran, rivaroxaban, and warfarin regarding stroke prevention and bleeding rates, respectively, in elderly patients with atrial fibrillation (AF) with multiple chronic conditions (MCC). The investigators concluded that oral anticoagulants were similarly effective in stroke prevention among patients with AF with MCC. However, the indicate that dabigatran and rivaroxaban use may be associated with lower rates of mortality in patients with MCC.
AHRQ-funded; HS023104.
Citation: Mentias A, Shantha G, Chaudhury P .
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
JAMA Netw Open 2018 Sep 7;1(5):e182870. doi: 10.1001/jamanetworkopen.2018.2870..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Medication, Evidence-Based Practice, Comparative Effectiveness, Chronic Conditions
Zhu J, Alexander GC, Nazarian S
Trends and variation in oral anticoagulant choice in patients with atrial fibrillation, 2010-2017.
This paper discusses trends in usage of oral anticoagulants in patients with atrial fibrillation from 2010 to 2017. Since 2010, several non-vitamin K antagonist oral coagulants (NOACs) have been brought to the US market. This study examined trends in usage. A cross-sectional analysis of medical and pharmacy claims was done for commercial and Medicare Advantage enrollees in a large, private, US Health plan. A total of 112,187 adults with nonvalvular AF starting OACs was identified. In the first quarter of 2017, out of 7502 patients starting OACs, 78.9% used NOACs and 21.1% warfarin. Usage of regular anticoagulants such as apixaban increases with age, female sex, stroke or bleeding risk and comorbidities. Warfarin and apixaban are generally preferred for elderly patients and patients with higher stroke or bleeding risk.
AHRQ-funded; HS024737.
Citation: Zhu J, Alexander GC, Nazarian S .
Trends and variation in oral anticoagulant choice in patients with atrial fibrillation, 2010-2017.
Pharmacotherapy 2018 Sep;38(9):907-20. doi: 10.1002/phar.2158..
Keywords: Blood Thinners, Cardiovascular Conditions, Healthcare Utilization, Heart Disease and Health, Medication
Turner TE, Saeed MJ, Novak E
Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality.
Despite the absence of data from randomized clinical trials, professional societies recommend inferior vena cava (IVC) filters for patients with venous thromboembolic disease (VTE) and a contraindication to anticoagulation therapy. Prior observational studies of IVC filters have suggested a mortality benefit associated with IVC filter insertion but have often failed to adjust for immortal time bias. The purpose of this study was to determine the association of IVC filter placement with 30-day mortality after adjustment for immortal time bias.
AHRQ-funded; HS019455.
Citation: Turner TE, Saeed MJ, Novak E .
Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality.
JAMA Netw Open 2018 Jul 6;1(3):e180452. doi: 10.1001/jamanetworkopen.2018.0452.
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Keywords: Blood Thinners, Cardiovascular Conditions, Care Management, Heart Disease and Health, Healthcare Cost and Utilization Project (HCUP), Medication, Outcomes
Wang SV, Huybrechts KF, Fischer MA
Generalized boosted modeling to identify subgroups where effect of dabigatran versus warfarin may differ: an observational cohort study of patients with atrial fibrillation.
The purpose of this study was to explore generalized boosted modeling (GBM) as a method for identifying subgroups with greater benefit or harm with dabigatran versus warfarin for treatment of atrial fibrillation. The investigators concluded that dabigatran's superiority to warfarin at prevention of thromboembolism may be greater in secondary than primary prevention. They indicated that in practice, secondary prevention patients are more often treated with warfarin.
AHRQ-funded; HS022193.
Citation: Wang SV, Huybrechts KF, Fischer MA .
Generalized boosted modeling to identify subgroups where effect of dabigatran versus warfarin may differ: an observational cohort study of patients with atrial fibrillation.
Pharmacoepidemiol Drug Saf 2018 Apr;27(4):383-90. doi: 10.1002/pds.4395..
Keywords: Blood Clots, Blood Thinners, Cardiovascular Conditions, Comparative Effectiveness, Evidence-Based Practice, Heart Disease and Health, Medication, Outcomes, Patient-Centered Outcomes Research, Prevention
Childers CP, Maggard-Gibbons M, Ulloa JG
Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review.
Researchers conducted a systematic review on the use of antiplatelet therapy (APT) after non-cardiac surgery (NCS) following stent placement surgery done previously. There has been some debate among the American College of Cardiology and American Heart Association as to the guidelines of how long to delay NCS after stent placement. Out of 4,882 articles, only 16 were included in the review. All of them were small. Reviewers looked for rates of cardiac events and/or bleeding events with the different APT strategies used. There did not seem to be much difference in outcomes between the different strategies.
AHRQ-funded; HS025079.
Citation: Childers CP, Maggard-Gibbons M, Ulloa JG .
Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review.
Syst Rev 2018 Jan 10;7(1):4. doi: 10.1186/s13643-017-0635-z..
Keywords: Adverse Drug Events (ADE), Blood Thinners, Cardiovascular Conditions, Care Management, Medication, Outcomes, Surgery