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Intern Emerg Med. 2017 Apr;12(3):311-318. doi: 10.1007/s11739-016-1552-1. Epub 2016 Oct 18.

Hospital length-of-stay and costs among pulmonary embolism patients treated with rivaroxaban versus parenteral bridging to warfarin.

Author information

1
School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Storrs, CT, 06269, USA.
2
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
3
Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
4
Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
5
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
6
Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
7
School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Storrs, CT, 06269, USA. craig.coleman@hhchealth.org.

Abstract

We sought to compare length-of-stay (LOS), total hospital costs, and readmissions among pulmonary embolism (PE) patients treated with rivaroxaban versus parenterally bridged warfarin. We identified adult PE (primary diagnostic code = 415.1x) patients in the Premier Database (11/2012-9/2015), and included those with ≥1 PE diagnostic test on days 0-2. Rivaroxaban users (allowing ≤2 days of prior parenteral therapy) were 1:1 propensity score matched to patients parenterally bridged to warfarin. LOS, total costs, and readmission for venous thromboembolism (VTE) or major bleeding within the same or subsequent 2 months were compared between cohorts. Separate analyses were performed in low-risk PE patients. Rivaroxaban use was associated with a 1.4-day [95 % confidence interval (CI) -1.47 to -1.28] shorter LOS, and $2322 (95 % CI -$2499 to -$2146) reduction in costs compared to parenterally bridged warfarin (p < 0.001 for both). There was no difference in readmission for VTE (1.5 versus 1.7 %) or major bleeding (0.3 versus 0.2 %) between the rivaroxaban and parenterally bridged warfarin cohorts (p ≥ 0.27 for both). Results were similar in low-risk patients (0.2-1.0 day and $251-$1751 reductions in LOS and costs, respectively, p ≤ 0.01 for all). In patients with PE, rivaroxaban was associated with reduced LOS and costs, without increased risk of readmission versus parenterally bridged warfarin. Similar results were observed in low-risk PE patients.

KEYWORDS:

Length-of-stay; Parenteral bridging; Pulmonary embolism; Rivaroxaban; Venous thromboembolism

PMID:
27757790
DOI:
10.1007/s11739-016-1552-1
[Indexed for MEDLINE]

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