Effectiveness and safety of rivaroxaban versus warfarin in patients with provoked venous thromboembolism

A paucity of real-world data evaluating rivaroxaban in provoked venous thromboembolism (VTE) exists. We assessed the effectiveness and safety of rivaroxaban versus warfarin in provoked VTE patients treated in routine practice. Using MarketScan claims data from 1/2012 to 12/2016, we identified adults who had ≥?1 primary hospitalization/emergency department discharge diagnosis code for VTE (index event) and a provoking factor, received rivaroxaban or warfarin as their first outpatient oral anticoagulant within 30-days of the index event and had ≥?12-month of insurance coverage prior the index VTE. Provoking factors included cancer, hospital admission for ≥?3-consecutive days over the prior 3-months, major surgery, trauma or fracture within 90-days or pregnancy within 42-weeks of the index VTE. Differences in baseline covariates between cohorts were adjusted using inverse probability-of-treatment weights based on propensity-scores (residual standardized differences <?0.1 achieved for all covariates after adjustment). The incidence of the composite endpoint of recurrent VTE or major bleeding at 3- and 6-months was compared using Cox regression and reported as hazard ratios (HRs) and 95% confidence intervals (CIs). We included 4454 rivaroxaban and 13,164 warfarin users with provoked VTE. At 3- and 6-months, rivaroxaban was associated with a reduced hazard of the composite endpoint (HR 0.72, 95% CI 0.61–0.84 and HR 0.69, 95% CI 0.60–0.80) and recurrent VTE (HR 0.70, 95% CI 0.59–0.84 and HR 0.71, 95% CI 0.60–0.84) versus warfarin. Major bleeding was non-significantly reduced at 3-months (HR 0.77, 95% CI 0.57–1.06) and significantly reduced at 6-months (HR 0.68, 95% CI 0.53–0.88) with rivaroxaban. Rivaroxaban reduces recurrent VTE and major bleeding risk versus warfarin in provoked VTE patients treated in routine practice.     

Beta prime regression with application to risky behavior frequency screening

Our aim is to model the frequency of certain behavioral acts, especially those that are likely to transmit communicable diseases between persons. We develop a generalized linear model on the basis of the beta prime distribution to model the responses to a survey question of the form, ‘When was the last time that you engaged in this behavior?’ Intuitively, individuals reporting more recent events are more likely to have greater frequency of the risky behavior. The beta prime distribution is especially suited to this application because of its long tail. We adjust for length‐biased sampling. We show how to use this distribution as the basis of a linear regression model that accounts for differences in demographic and psychological characteristics of the respondents. We discuss estimation of parameters, residuals, tests for heterogeneity of these parameters, and jackknife measures of influence. We apply the methods to a survey of alcohol abuse use among individuals who are at high risk for spreading HIV and other communicable diseases in a study conducted in Saint Petersburg, Russia. Copyright © 2013 John Wiley & Sons, Ltd.     

Impact of Multifocality and Multilocation of Positive Surgical Margin After Radical Prostatectomy on Predicting Oncological Outcome

Objective

To assess the impact of focality and location of positive surgical margins (PSM) on long-term outcomes after radical prostatectomy (RP) for prostate cancer (PCa), including biochemical recurrence (BCR), metastasis and overall mortality.