Browsing by Author "Amin, Alpesh"

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Comparison of Major-Bleeding Risk and Health Care Costs Among Treatment-Naïve Non-Valvular Atrial Fibrillation Patients Initiating Apixaban, Dabigatran, Rivaroxaban, or Warfarin
(2015) Amin, Alpesh; Keshishian, A; Xie, L; Başer, Onur; Price, K; Vo, L; Singh, P; Bruno, A; Mardekian, J; Tan, W; Singhal, S; Patel, C; Odell, K; Trocio J.
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Real-World Comparison of Major Bleeding and Associated Costs Among Treatment-Naïve Nonvalvular Atrial Fibrillation Patients Initiating Apixaban or Warfarin
(2016) Amin, Alpesh; Keshishian, A; Xie L; Başer, Onur; Price, K; Vo, L; Mardekian, J; Mendoza, M; Singhal, S; Patel, C; Odell, K; Trocio, J
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Real-World Comparison of Major Bleeding Risk Among Untreated Non-Valvular Atrial Fibrillation Patients and Those Initiating Apixaban, Dabigatran, Rivaroxaban, or Warfarin
(2016) Amin, Alpesh; Keshishian, A; Xie, L; Başer, Onur; Price, K; Lien Vo; Mardekian, J; Mendoza, M; Singhal, S; Patel, C; Odell, K; Trocio J.
Background: Recent large randomized controlled trials have shown that novel oral anticoagulants (NOACs) are at least as effective as warfarin for risk reduction of stroke in patients with non-valvular atrial fibrillation (NVAF) and are associated with similar or lower rates of bleeding. The study aim was to compare major bleeding risk among untreated NVAF patients to those initiating apixaban, dabigatran, rivaroxaban or warfarin
Citation - WoS: 59
Citation - Scopus: 60
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
(2017) Amin, Alpesh; Lien Vo; Trocio, Jeffrey; Keshishian, A; Liu, Xianchen; Mardekian, Jack; Zhang, Qisu; Rosenblatt, Lisa; Dina, Oluwaseyi; Başer, Onur; Le, Hannah
Objective: To compare the risk and cost of stroke/systemic embolism (SE) and major bleeding between each direct oral anticoagulant (DOAC) and warfarin among non-valvular atrial fibrillation (NVAF) patients. Methods: Patients (65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Medicare database from 1 January 2013 to 31 December 2014. Patients initiating each DOAC were matched 1:1 to warfarin patients using propensity score matching to balance demographics and clinical characteristics. Cox proportional hazards models were used to estimate the risks of stroke/SE and major bleeding of each DOAC vs. warfarin. Two-part models were used to compare the stroke/SE- and major-bleeding-related medical costs between matched cohorts. Results: Of the 186,132 eligible patients, 20,803 apixaban-warfarin pairs, 52,476 rivaroxaban-warfarin pairs, and 16,731 dabigatran-warfarin pairs were matched. Apixaban (hazard ratio [HR]=0.40; 95% confidence interval [CI] 0.31, 0.53) and rivaroxaban (HR=0.72; 95% CI 0.63, 0.83) were significantly associated with lower risk of stroke/SE compared to warfarin. Apixaban (HR=0.51; 95% CI 0.44, 0.58) and dabigatran (HR=0.79; 95% CI 0.69, 0.91) were significantly associated with lower risk of major bleeding; rivaroxaban (HR=1.17; 95% CI 1.10, 1.26) was significantly associated with higher risk of major bleeding compared to warfarin. Compared to warfarin, apixaban ($63 vs. $131) and rivaroxaban ($93 vs. $139) had significantly lower stroke/SE-related medical costs; apixaban ($292 vs. $529) and dabigatran ($369 vs. $450) had significantly lower major bleeding-related medical costs. Conclusions: Among the DOACs in the study, only apixaban is associated with a significantly lower risk of stroke/SE and major bleeding and lower related medical costs compared to warfarin.