Post-Discharge Treatment Patterns among Patients Treated with Apixaban or Warfarin during Hospitalization for Venous Thromboembolism (VTE).

Background: Oral anticoagulants (OACs), such as apixaban and warfarin, are indicated for reducing the risk of recurrent venous thromboembolism (VTE) and are often initiated in the hospital. The aim of this study was to evaluate OAC continuity from inpatient to outpatient settings and the risk of recurrent VTE among patients with an initial event. Methods: This retrospective cohort study utilized hospital charge data and medical and prescription claims from 1 July 2016 to 31 December 2022 to identify adults treated with apixaban or warfarin while hospitalized for VTE. Patients were followed to assess switching or discontinuation post-discharge and the risk of recurrent VTE. The index date was the date of the first apixaban or warfarin claim within 30 days post-discharge. Results: Of the 19,303 eligible patients hospitalized with VTE, 85% (n = 16,401) were treated with apixaban and 15% (n = 2902) received warfarin. After discharge, approximately 70% had ≥1 fill for their respective apixaban or warfarin therapy. The cumulative incidence of discontinuation over the 6 months following index was 50.5% and 52.2% for the apixaban and warfarin cohorts, respectively; the cumulative incidence of switching was 6.0% and 20.9%, respectively. The incidence rates of recurrent VTE were 1.2 and 2.5 per 100 person-years for the apixaban and warfarin cohorts, respectively. Conclusions: The majority of patients continued their apixaban or warfarin therapy following hospital discharge; however, a considerable proportion either switched or discontinued OAC upon transitioning from inpatient care. Among those who continued therapy, discontinuation, switch, and recurrent VTE occurred less often with apixaban vs. warfarin.

Awareness, attitudes, and practices on meningococcal serogroup B vaccination in the United States among parents of older adolescents and among young adults.

OBJECTIVE: Meningococcal serogroup B (MenB) vaccination is recommended by the Advisory Committee on Immunization Practices (ACIP) for adolescents and young adults 16-23-years-old under shared clinical decision-making (SCDM). However, MenB vaccination coverage in this population remains low in the United States (US). We investigated the awareness, attitudes, and practices regarding MenB disease and vaccination among parents of 16-18-year-old older adolescents and among 19-23-year-old young adults. METHODS: An online survey was conducted in September-October 2022 among parents of older adolescents and among young adults recruited from a US-based patient panel. RESULTS: There were 606 total participants, including parents of MenB-vaccinated (n = 151) and non-vaccinated (n = 154) adolescents, and also MenB-vaccinated (n = 150) and non-vaccinated (n = 151) young adults. Non-vaccinated cohorts reported low awareness of MenB disease (58.3-67.5%) and vaccination (49.7-61.0%), though awareness was higher among non-vaccinated parents. However, all cohorts reported high interest in learning more about MenB disease and vaccination. Vaccinated cohorts relied on primary care providers (PCPs) to initiate MenB vaccination conversation and had a low awareness of SCDM at 35.1-45.3%, though those aware of SCDM were more likely to participate in decision-making. Barriers to MenB vaccination included lack of PCP recommendation, vaccine side effects, and uncertainty about vaccination need. CONCLUSIONS: There are gaps in awareness of MenB disease, vaccination, and SCDM among parents and patients in the US, resulting in missed opportunities for discussing and administering MenB vaccination. Targeted education on MenB and vaccination recommendations may increase these opportunities and improve MenB vaccination awareness and initiation.

MenB disease, a type of meningitis, is a serious and life-threatening illness. The US Centers for Disease Control and Prevention (CDC) recommends that 16­23-year-olds get a MenB vaccine after talking with their healthcare provider and deciding it is the right choice. As of 2021, only about 3 in 10 17-year-olds had received a MenB vaccine. In this study, we used an online survey to learn about parents of older teens' (16­18-years-old) and young adults' (19­23-years-old) awareness, thoughts, and practices related to meningitis and the MenB vaccine. Parents of non-vaccinated teens, and non-vaccinated young adults, had a lower awareness of the causes, risks, and symptoms of meningitis, and the MenB vaccine. In addition, most parents thought the impact of meningitis would be severe, compared with young adults who thought it would be less severe. Most participants were also not aware of their role in deciding if they or their child should be vaccinated against MenB. However, most showed a high interest in learning more about meningitis and the MenB vaccine. We also found that most teens and young adults who did receive the MenB vaccine received it right after talking about it with their healthcare provider. These findings show a clear opportunity to address gaps in awareness and thoughts about meningitis and MenB vaccination. Providing education and resources to parents, young adults, and healthcare providers could create more opportunities to discuss MenB vaccination and lead to more teens and young adults accessing vaccination and being protected against meningitis.