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http://dx.doi.org/10.1016/j.jacc.2025.06.020 | DOI Listing |
J Med Econ
September 2025
Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom.
Background: Medicare plans employ drug utilization management strategies, including prior authorization (PA) and step therapy (ST), or formulary tier increases, to control spending. However, PA and ST can delay treatment access and encourage use of less effective/safe therapies, while formulary tier increases can lead to treatment switching/discontinuation due to higher patient out-of-pocket costs. This study modeled the impact of restricted access to direct oral anticoagulants (DOACs), and a tier increase for apixaban, on incidence and cost of clinical events in patients with non-valvular atrial fibrillation (NVAF) in the United States.
View Article and Find Full Text PDFCirc Cardiovasc Qual Outcomes
August 2025
Harvard Medical School, Boston, MA (D.H.K., D.K., D.E.S., K.J.L.).
Background: The benefits of switching from warfarin to direct oral anticoagulants in atrial fibrillation remain unclear.
Methods: This retrospective study used the Medicare fee-for-service (2013-2020) and Optum Deidentified Clinformatics Data Mart databases (2013-2023). Among patients with atrial fibrillation who received warfarin for at least 180 days, we created 2 cohorts: (1) patients switching to apixaban versus continuing warfarin (the apixaban cohort) and (2) patients switching to rivaroxaban versus continuing warfarin (the rivaroxaban cohort).
J Thromb Haemost
August 2025
Department Internal Medicine, Rijnstate hospital, Arnhem, The Netherlands.
Background: Absorption of apixaban, a direct oral anticoagulant (DOAC), may be impaired after metabolic and bariatric surgery (MBS). The Dutch guideline advises to switch to vitamin K antagonists (VKA), while patients prefer the use of DOACs. Apixaban is not regularly prescribed after MBS due to a lack of evidence regarding its efficacy and safety.
View Article and Find Full Text PDFPost Reprod Health
August 2025
King's College Hospital, London, United Kingdom.
ObjectiveTo assess the risk of further thrombosis with using HRT containing transdermal estradiol in women with a personal history of venous thromboembolism (VTE) or arterial thromboembolism (ATE).MethodsWe undertook analysis of patients with a history of VTE/ATE who had been seen in the menopause clinic at King's College Hospital. They were followed up for a minimum of a 12 months period to assess for recurrence of VTE/ATE.
View Article and Find Full Text PDFFuture Cardiol
August 2025
University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.