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Int J Clin Pract. 2017 Jan;71(1). doi: 10.1111/ijcp.12915.

Shortened hospital length of stay and lower costs associated with rivaroxaban in patients with pulmonary embolism managed as observation status.

Author information

1
University of Connecticut School of Pharmacy, Storrs, CT, USA.
2
Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
3
Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
4
Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, USA.
5
Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
6
Janssen Scientific Affairs, LLC, Raritan, NJ, USA.

Abstract

BACKGROUND:

Unlike rivaroxaban, treatment of patients with pulmonary embolism (PE) with warfarin requires parenteral bridging and coagulation monitoring that may prolong length-of-stay (LOS) and increase hospital costs.

AIMS:

The aim of this study was to compare LOS, hospital costs and readmissions in PE patients managed through observation stays treated with rivaroxaban or parenterally bridged warfarin.

METHODS:

Premier Hospital claims data from November 2012 to March 2015 were used to identify patients with a primary diagnosis code for PE managed through an observation stay and with ≥1 claim for a PE-related diagnostic test on day 0-2. Rivaroxaban users, allowing ≤2 days of prior parenteral therapy, were 1:1 propensity-score matched to patients receiving parenterally bridged warfarin. LOS, the proportion of encounters lasting >2 midnights, total hospital costs of the index visit and risk of readmission for venous thromboembolism (VTE) or major bleeding during the same month or 2 months subsequent to the index event were compared between matched cohorts using multivariable regression.

RESULTS:

A total of 312 rivaroxaban users were matched to 312 patients receiving parenterally bridged warfarin. Rivaroxaban was associated with an average of 0.27-day shorter LOS, a 52% decreased odds of an encounter lasting >2 midnights and a $403 mean reduction in costs vs parenterally bridged warfarin (P≤.002 for all). The readmission rate for VTE during the same or subsequent 2 months following the index PE was similar between cohorts (P=.75). No patient in either cohort was readmitted for major bleeding.

CONCLUSION:

Rivaroxaban was associated with shortened LOS and lowered cost vs parenterally bridged warfarin in PE observation stay patients, without increases in the short-term rate of complications or readmission.

KEYWORDS:

length-of-stay; parenteral bridging; pulmonary embolism; rivaroxaban; thromboembolism; venous

PMID:
28097761
DOI:
10.1111/ijcp.12915
[Indexed for MEDLINE]

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