{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T00:09:26Z","timestamp":1715645366410},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>\n              Although recommended by guidelines, the benefits of treating patients with atrial fibrillation with a low\u2013stroke risk score, with aspirin or anticoagulants, have not been clearly established. With advent of safer non\u2013vitamin K antagonist oral anticoagulant, we assessed the clinical and economic implications of 5 mg BID of apixaban versus aspirin among patients with a relative low risk of stroke as assessed using the CHADS\n              <jats:sub>2<\/jats:sub>\n              (congestive heart failure, hypertension, age&gt;75, diabetes mellitus, stroke\/transient ischemic attack) and CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              \u2013VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke\/transient ischemic attack, vascular disease) stroke risk classification.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>\n              A previously developed and validated Markov model was adapted. A secondary analysis of the Apixaban Versus Acetylsalicylic Acid to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment (AVERROES) study was conducted to estimate event rates in different low-risk cohorts by treatment. Three cohorts (n=1000) with a CHADS\n              <jats:sub>2<\/jats:sub>\n              score of 1, CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              \u2013VASc score of 1, and CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              \u2013VASc of score 2 to 4 were simulated to assess the number of clinical events avoided in terms of strokes and major bleeds, as well as life years gained, quality-adjusted life years gained, costs, and incremental costs per quality-adjusted life year gained.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>Apixaban was associated with fewer strokes and systemic embolism versus aspirin across all subgroups; however, it caused more major bleeding events. The reduction in systemic embolism offset the increase in major bleeding events leading to increased life expectancy and quality-adjusted life year gains, achieved at an increased cost that was lower than the UK threshold of $44\u2009400 (ie, \u00a330\u2009000) per quality-adjusted life year gained across the 3 cohorts examined.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>\n              Anticoagulant treatment with apixaban versus aspirin in low-risk patients, as identified using CHADS\n              <jats:sub>2<\/jats:sub>\n              or CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              \u2013VASc, is projected to increase life expectancy and provide clinical benefits that are cost effective.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.115.009995","type":"journal-article","created":{"date-parts":[[2015,8,28]],"date-time":"2015-08-28T03:14:09Z","timestamp":1440731649000},"page":"2830-2837","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical and Economic Implications of Apixaban Versus Aspirin in the Low-Risk Nonvalvular Atrial Fibrillation Patients"],"prefix":"10.1161","volume":"46","author":[{"given":"Gregory Y.H.","family":"Lip","sequence":"first","affiliation":[{"name":"From the Centre for Cardiovascular Science, City Hospital, University of Birmingham, Birmingham, United Kingdom (G.Y.H.L.); Thrombosis Research Unit, Aalborg University, Aalborg, Denmark (G.Y.H.L.); Modeling and Simulation, Evidera, London, United Kingdom (T.L., T.K.); Statistics, Pfizer, New York, NY (J.M.); US Health Economics &amp; Outcomes Research, EMD Serono, Rockland, MA (H.P.); and Division of Cardiology, University of Toronto, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (P.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tereza","family":"Lanitis","sequence":"additional","affiliation":[{"name":"From the Centre for Cardiovascular Science, City Hospital, University of Birmingham, Birmingham, United Kingdom (G.Y.H.L.); Thrombosis Research Unit, Aalborg University, Aalborg, Denmark (G.Y.H.L.); Modeling and Simulation, Evidera, London, United Kingdom (T.L., T.K.); Statistics, Pfizer, New York, NY (J.M.); US Health Economics &amp; Outcomes Research, EMD Serono, Rockland, MA (H.P.); and Division of Cardiology, University of Toronto, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (P.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Mardekian","sequence":"additional","affiliation":[{"name":"From the Centre for Cardiovascular Science, City Hospital, University of Birmingham, Birmingham, United Kingdom (G.Y.H.L.); Thrombosis Research Unit, Aalborg University, Aalborg, Denmark (G.Y.H.L.); Modeling and Simulation, Evidera, London, United Kingdom (T.L., T.K.); Statistics, Pfizer, New York, NY (J.M.); US Health Economics &amp; Outcomes Research, EMD Serono, Rockland, MA (H.P.); and Division of Cardiology, University of Toronto, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (P.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thitima","family":"Kongnakorn","sequence":"additional","affiliation":[{"name":"From the Centre for Cardiovascular Science, City Hospital, University of Birmingham, Birmingham, United Kingdom (G.Y.H.L.); Thrombosis Research Unit, Aalborg University, Aalborg, Denmark (G.Y.H.L.); Modeling and Simulation, Evidera, London, United Kingdom (T.L., T.K.); Statistics, Pfizer, New York, NY (J.M.); US Health Economics &amp; Outcomes Research, EMD Serono, Rockland, MA (H.P.); and Division of Cardiology, University of Toronto, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (P.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemant","family":"Phatak","sequence":"additional","affiliation":[{"name":"From the Centre for Cardiovascular Science, City Hospital, University of Birmingham, Birmingham, United Kingdom (G.Y.H.L.); Thrombosis Research Unit, Aalborg University, Aalborg, Denmark (G.Y.H.L.); Modeling and Simulation, Evidera, London, United Kingdom (T.L., T.K.); Statistics, Pfizer, New York, NY (J.M.); US Health Economics &amp; Outcomes Research, EMD Serono, Rockland, MA (H.P.); and Division of Cardiology, University of Toronto, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (P.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Dorian","sequence":"additional","affiliation":[{"name":"From the Centre for Cardiovascular Science, City Hospital, University of Birmingham, Birmingham, United Kingdom (G.Y.H.L.); Thrombosis Research Unit, Aalborg University, Aalborg, Denmark (G.Y.H.L.); Modeling and Simulation, Evidera, London, United Kingdom (T.L., T.K.); Statistics, Pfizer, New York, NY (J.M.); US Health Economics &amp; Outcomes Research, EMD Serono, Rockland, MA (H.P.); and Division of Cardiology, University of Toronto, St. Michael\u2019s Hospital, Toronto, Ontario, Canada (P.D.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.002329"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.22.8.983"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.654145"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs253"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euq350"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH13-06-0443"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eul097"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1584"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d124"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr488"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2304"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH12-08-0539"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2009.11.025"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905561"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009638"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310907"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1007432"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000024"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu006"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2013.12.011"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X11401031"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1996.00440150083009"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.2174\/1874192401004020078"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2012.00812.x"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2009.12.023"},{"key":"e_1_3_3_29_2","first-page":"669","article-title":"Neutropenia-related costs in patients treated with first-line chemotherapy for advanced non-small cell lung cancer.","volume":"15","author":"Stokes ME","year":"2009","unstructured":"Stokes ME, Muehlenbein CE, Marciniak MD, Faries DE, Motabar S, Gillespie TW, et al.. 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