Antithrombotic Therapy for VTE Disease

Kearon, Clive; Akl, Elie A.; Comerota, Anthony J.; Prandoni, Paolo; Bounameaux, Henri; Goldhaber, Samuel Z.; Nelson, M. E.; Wells, Philip S.; Gould, Michael K.; Dentali, Francesco; Crowther, Mark; Kahn, Susan R.

doi:10.1378/chest.11-2301

Cited by 3,620 publications

(1,194 citation statements)

References 446 publications

Supporting

Mentioning

1,152

Contrasting

Unclassified

Order By: Relevance

“…Our study reported a larger percentage of primary PE hospitalizations (61%) compared with primary DVT (39%), which is consistent with the 2012 evidence‐based guidelines for VTE antithrombotic therapy recommending home treatment (when possible) for acute DVT and hospitalization for PE due to higher associated short‐term PE mortality 5. This is also consistent with the EINSTEIN trials in which 52% of DVT patients and 90% of PE patients were hospitalized 10.…”

Section: Discussionsupporting

confidence: 90%

“…This study's results combined data from both primary DVT and primary PE patient hospitalizations, a priori, as it has been reported that a majority of patients diagnosed with DVT will also have PE (symptomatic or asymptomatic), and likewise for PE, and further that the anticoagulant clinical trials showed similar estimates of efficacy and safety with either indication alone and in patients with both DVT and PE 5. Our study reported a larger percentage of primary PE hospitalizations (61%) compared with primary DVT (39%), which is consistent with the 2012 evidence‐based guidelines for VTE antithrombotic therapy recommending home treatment (when possible) for acute DVT and hospitalization for PE due to higher associated short‐term PE mortality 5.…”

Section: Discussionmentioning

confidence: 99%

“…Standard therapy for VTE is early treatment with parenteral anticoagulation, with the main goals of preventing extension and recurrence of the thrombotic event 5. Acute DVT is more often treated at home than in the hospital, while acute PE is typically treated in the hospital since it is associated with much higher short‐term mortality 5.…”

Section: Introductionmentioning

confidence: 99%

“…Acute DVT is more often treated at home than in the hospital, while acute PE is typically treated in the hospital since it is associated with much higher short‐term mortality 5. Anticoagulation has traditionally been initiated with subcutaneous or intravenous heparin, either low‐molecular‐weight heparin or unfractionated heparin, given in combination with a vitamin K antagonist (VKA), most commonly warfarin, started concurrently or shortly after initiating the heparin therapy 5.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Margolis

Deitelzweig

Kline

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundVenous thromboembolism, including deep vein thrombosis and pulmonary embolism, results in a substantial healthcare system burden. This retrospective observational study compared hospital length of stay (LOS) and hospitalization costs for patients with venous thromboembolism treated with rivaroxaban versus those treated with warfarin.Methods and ResultsHospitalizations for adult patients with a primary diagnosis of deep vein thrombosis or pulmonary embolism who were initiated on rivaroxaban or warfarin were selected from MarketScan's Hospital Drug Database between November 1, 2012, and December 31, 2013. Patients treated with warfarin were matched 1:1 to patients treated with rivaroxaban using exact and propensity score matching. Hospital LOS, time from first dose to discharge, and hospitalization costs were reported descriptively and with generalized linear models (GLMs). The final study cohorts each included 1223 patients (751 with pulmonary embolism and 472 with deep vein thrombosis). Cohorts were well matched for demographic and clinical characteristics. Mean (±SD) LOS was 3.7±3.1 days for patients taking rivaroxaban and 5.2±3.7 days for patients taking warfarin, confirmed by GLM‐adjusted results (rivaroxaban 3.7 days, warfarin 5.3 days, P<0.001). Patients with provoked venous thromboembolism admissions showed longer LOSs (rivaroxaban 5.1±4.5 days, warfarin 6.5±5.6 days, P<0.001) than those with unprovoked venous thromboembolism (rivaroxaban 3.3±2.4 days, warfarin 4.8±2.8 days, P<0.001). Days from first dose to discharge were 2.4±1.7 for patients treated with rivaroxaban and 3.9±3.7 for patients treated with warfarin when initiated with parenteral anticoagulants (P<0.001), and 2.7±1.7 and 3.7±2.1, respectively, when initiated without parenteral anticoagulants (P<0.001). Patients initiated on rivaroxaban incurred significantly lower mean total hospitalization costs ($8688±$9927 versus $9823±$9319, P=0.004), confirmed by modeling (rivaroxaban $8387 [95% confidence interval, $8035–$8739]; warfarin $10 275 [95% confidence interval, $9842–$10 708]).ConclusionsRivaroxaban was associated with significantly shorter hospital LOS and lower hospitalization costs compared with warfarin.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Margolis

Deitelzweig

Kline

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…Meta-analysis of five prospective studies of hemodynamically stable PE demonstrated that 44% of patients had RV dysfunction and a higher mortality rate with a sensitivity of 70%, a positive predictive value of 58%, and a negative predictive value of 60% for prediction of mortality [12]. In another study, the prognostic value of echocardiogram in hemodynamically stable PE patients was moderate [13].…”

Section: Discussionmentioning

confidence: 99%

Predictors of hospital stay in normotensive acute pulmonary embolism: a retrospective pilot study

Mukhtar

Alhafidh

Khalid

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

Introduction: The aim of our study is to determine the clinical, biochemical, and imaging factors that affect the duration of hospital stay in patients admitted with normotensive acute pulmonary embolism.Methods: This was a single-center retrospective study conducted in a community hospital in New York metropolitan area for patients admitted from October 2015 to October 2017.Results: A total of 79 patients were included, the mean age was 55.76 (SD = 17.33), 29 cases were males (37%) and 50 cases were females (63%). Among all patients, 17 cases had short length of stay (LOS) (≤2 days) and 62 cases had long LOS (>2 days). There were statistically significant differences in age (p = .041), presence of lung disease (p = .036), number of comorbidities (p = .043), and pulmonary embolism severity index (PESI) scores (original and simplified; p = .002 and .001, respectively). Logistic regression analysis showed that PESI score significantly predicted long LOS (OR 1.067, 95% CI [1.001, 1.137], p = .048). Similarly, sPESI significantly predicted long LOS (OR 0.223, 95% CI [0.050, 0.999], p = .050). Both regression models were adjusted for age, lung disease, and number of comorbidities.Conclusion: Both original and simplified PESI scores were statistically significant predictors of duration of hospital stay. Patients with multiple comorbidities or with chronic lung disease were also likely to have prolonged hospital stay. None of the cardiac biomarkers affected the duration of hospital stay, neither did the presence of right ventricular dysfunction nor treatment modality.

show abstract

Risk of Thromboembolism, Recurrent Hemorrhage, and Death After Warfarin Therapy Interruption for Gastrointestinal Tract Bleeding

Witt

Delate

García³

et al. 2012

Arch Intern Med

207

164

View full text Add to dashboard Cite

show abstract

Antithrombotic Therapy for VTE Disease

Abstract: Strong recommendations apply to most patients, whereas weak recommendations are sensitive to differences among patients, including their preferences.

Cited by 3,620 publications

References 446 publications

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Predictors of hospital stay in normotensive acute pulmonary embolism: a retrospective pilot study

Risk of Thromboembolism, Recurrent Hemorrhage, and Death After Warfarin Therapy Interruption for Gastrointestinal Tract Bleeding

Contact Info

Product

Resources

About