Initiation of direct oral anticoagulants versus warfarin for venous thromboembolism: impact on time to hospital discharge

Abstract

The objective of this project was to compare the time from initiation of oral anticoagulation to hospital discharge between warfarin and direct oral anticoagulants (DOACs) for the treatment of acute venous thromboembolism (VTE). This retrospective observational study was done at a single VA medical center. A total of 107 patients were included, with 42 patients (39%) in the DOAC group, which included rivaroxaban, dabigatran, and apixaban, and 65 patients (61%) in the warfarin group. Variables collected through chart review included comorbid conditions, time from initiation of oral anticoagulation to discharge, emergency department (ED) visits and readmission within 30 or 90 days, and bleeding events. The DOAC group had a shorter time to discharge compared to the warfarin group (28 vs. 114 h, p < 0.001). There were similar 30 and 90-day hospital readmission rates and/or ED visits for DOACs (23.8 and 33.3%) compared to warfarin (18.5 and 30.8%), including those related to bleeding of any severity (11.9% for DOACs vs. 9.2% for warfarin; p = 0.75). There was one major bleeding event in the DOAC group and two in the warfarin group. The use of DOACs for the treatment of acute VTE in hospitalized patients was associated with shorter time to hospital discharge when compared to warfarin.

Inpatient pharmacy‐driven antithrombosis stewardship efforts on warfarin to direct oral anticoagulant conversions

“…In studies assessing factors associated with rates of readmission in patients on anticoagulants, warfarin has been associated with increased readmissions as soon as 30 days 23 . Thirty and 90‐day readmission is a common outcome of other trials evaluating safety between warfarin and DOACs 24 . Data suggests that the initial period after starting an anticoagulant tends to be associated with the highest risk of bleeding, while rates of bleeding after 90 days tend to decline 25 .…”

“…23 Thirty and 90-day readmission is a common outcome of other trials evaluating safety between warfarin and DOACs. 24 Data suggests that the initial period after starting an anticoagulant tends to be associated with the highest risk of bleeding, while rates of bleeding after 90 days tend to decline. 25 Adherence to anticoagulants post-discharge may also be quite low.…”

Compared to randomized studies, observational studies may overestimate the effectiveness of DOACs: a metaepidemiological approach

“…Three studies [20][21][22] were excluded because they evaluated the same patients as two other larger studies [23,24], and more than half of their enrollment periods overlapped with those of the other studies. Finally, 26 studies (totalling 276,092 patients) were included : 6 RCTs [25-30], 4 prospective cohort studies [31][32][33][34], 12 studies using living databases (2 using living clinical databases [35][36] and 10 using living health administrative databases [18,23,24,[37][38][39][40][41][42][43]), and 4 retrospective cohort studies [44][45][46][47].…”

The anticoagulation length of therapy and risk of new adverse events in venous thromboembolism (ALTERNATIVE) study: Design and survey results

“…These include oral vitamin K antagonists (primarily warfarin) and direct oral anticoagulants (DOACs) including dabigatran, rivaroxaban, apixaban, and edoxaban [ 8 – 10 ]. DOACs offer advantages over warfarin such as fewer drug-drug interactions, fewer dietary restrictions, less routine lab monitoring and standardized drug dosing [ 11 ]. However, DOACs are more costly and like all anticoagulants, can increase the risk of bleeding [ 12 ].…”