Comparing Length of Stay Between Patients Taking Rivaroxaban and Conventional Anticoagulants for Treatment of Venous Thromboembolism

Desai, Amishi; Calixte, Rose; Aparnath, Malaygiri; Hindenburg, Alexander; Salzman, Steve H.; Mathew, Joseph

doi:10.1007/s00408-016-9898-8

Cited by 16 publications

(23 citation statements)

References 20 publications

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“… 19 Similarly, a single American institution identified those discharged on rivaroxaban compared with warfarin had shorter hospital stays (3.5 and 7 days, respectively; p<0.001). 23 Our study also identified a shorter length of stay among patients receiving a DOAC, consistent with these data ( table 3 ). 19 22 23 Our results, however, may have been confounded by those having more severe thrombosis receiving traditional therapies.…”

Section: Discussionsupporting

confidence: 89%

Anticoagulant therapies for acute venous thromboembolism among a cohort of patients discharged from Canadian urban and rural hospitals

et al. 2018

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ObjectiveTo determine anticoagulant therapy at hospital discharge for patients with acute venous thromboembolism (VTE) and secondarily, to describe factors affecting choice of therapy.DesignA retrospective chart review.SettingCanadian hospitals in Edmonton, Alberta (n=4), Regina, Saskatchewan (n=2) and rural Alberta (n=3) from April 2014 to March 2015.ParticipantsAll patients discharged with an acute VTE were screened. Those with atypical clots, another indication for anticoagulation, pregnancy/breast feeding or lifespan <3 months were excluded.Primary and secondary outcomesPrimarily, we identified the proportion of patients discharged from hospital with acute VTE that were prescribed either traditional therapy (parenteral anticoagulant±warfarin) or a direct oral anticoagulant (DOAC). Secondarily, management based on setting, therapy choice based on deep vein thrombosis (DVT) versus pulmonary embolism (PE), clot burden and renal function was compared. DOAC dosing was assessed (when prescribed), length of hospital stay based on therapy was compared and planned follow-up in the community was described.ResultsAmong the 695 patients included, most were discharged following a diagnosis of PE (82.9%) on traditional therapy (parenteral anticoagulant±warfarin) (70.2%) with follow-up by either a family doctor (51.5%) or specialist/clinic (46.9%) postdischarge. Regional variation was most evident between urban and rural sites. Of those prescribed a DOAC (28.3%), the majority were dosed appropriately (85.8%). DOAC use did not differ between those with DVT and PE, was proportionately higher for less severe clots and declined with worsening renal function. Patients prescribed DOACs versus traditional therapy had a shorter length of stay (4 vs 7 days, respectively).ConclusionsUptake of DOAC therapy for acute VTE was modest and may have been influenced by the timing of the audit in relation to the approval of these agents for this indication. Future audits should occur to assess temporal changes and ongoing appropriateness of care delivery.

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Section: Discussionsupporting

confidence: 89%

Anticoagulant therapies for acute venous thromboembolism among a cohort of patients discharged from Canadian urban and rural hospitals

et al. 2018

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“…Of the eight studies reporting both IP and OP treatments, seven reported both IP and OP DOAC use16–22 (rivaroxaban, dabigatran, and apixaban), five reported IP VKA use17–19,21,22 (warfarin) and seven reported OP VKA use17–23 (warfarin), six reported IP IAC use,17,18,20–23 (enoxaparin and LMWH), and four reported OP IAC use17,18,21,22 (enoxaparin and LMWH).…”

Section: Resultsmentioning

confidence: 99%

Systematic literature review of treatment patterns for venous thromboembolism patients during transitions from inpatient to post-discharge settings

Trocio¹,

Rosen²,

Gupta³

et al. 2018

CEOR

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IntroductionDirect oral anticoagulants (DOACs) have emerged as viable alternatives to traditional treatments such as vitamin K antagonists (VKAs) for venous thromboembolism (VTE). The objective of this review was to summarize evidence on the use of DOACs and VKAs to treat VTE in the US for patients transitioning from inpatient to post-discharge settings.Materials and methodsA systematic review of the VTE literature identified studies published in English (January 1, 2011–December 31, 2016) that reported inpatient and post-discharge treatments and discharge location. Two reviewers screened abstracts, abstracted information from included studies, and assessed the quality of the study methodology and reporting.ResultsForty-nine studies were included (24 clinical and 25 economic). A limited number of studies (eight clinical and three economic) examined VTE treatment patterns during transitions of care from inpatient to post-discharge settings, irrespective of anticoagulant (eg, DOAC, warfarin, heparin), and < 25% of all studies reported a post-discharge location. Three clinical studies that reported inpatient and outpatient treatment found better patient outcomes with DOAC vs warfarin. Fourteen economic studies reported that DOACs were associated with shorter hospital length of stay (LOS) and lower direct costs vs warfarin. No studies reported indirect costs.DiscussionAlthough DOACs are associated with shorter LOS, lower costs, and better patient outcomes vs VKAs, it appears in one study that only a small percentage of patients with stable VTE who are discharged to home may be receiving DOACs.ConclusionThese findings identified the potential areas of opportunity to improve the management of VTE through coordination of care from the inpatient to the outpatient settings.

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“…Component costs add to less than total inpatient costs because of ratios of costs to charges rounding. 18 of VTE-treated patients (N ¼ 414) at one institution with significantly shorter LOS for rivaroxaban than those discharged with a warfarin prescription (3.5 vs 7.0 days, P o .001). Cohort sizes in these studies were substantially smaller than the present study and not geographically diverse, which may contribute to differences in findings.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism Inpatients Treated With Rivaroxaban Had Shorter Hospital Stays and Lower Costs Compared With Warfarin

Margolis

Deitelzweig

Kline

et al. 2016

Clinical Therapeutics

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Comparing Length of Stay Between Patients Taking Rivaroxaban and Conventional Anticoagulants for Treatment of Venous Thromboembolism

Abstract: In patients admitted with newly diagnosed VTE, those discharged on rivaroxaban had a significantly shorter LOS compared to those discharged on warfarin. In the appropriate subset of patients with VTE, treatment with rivaroxaban may result in significant cost savings for the hospital.

Cited by 16 publications

References 20 publications

Anticoagulant therapies for acute venous thromboembolism among a cohort of patients discharged from Canadian urban and rural hospitals

Anticoagulant therapies for acute venous thromboembolism among a cohort of patients discharged from Canadian urban and rural hospitals

Systematic literature review of treatment patterns for venous thromboembolism patients during transitions from inpatient to post-discharge settings

Pulmonary Embolism Inpatients Treated With Rivaroxaban Had Shorter Hospital Stays and Lower Costs Compared With Warfarin

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