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

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Abstract

Background

Recent studies have demonstrated non-inferiority of rivaroxaban when compared to warfarin for the treatment of pulmonary embolism and deep venous thrombosis. Analysis of data from the EINSTEIN trials has demonstrated that patients who received rivaroxaban had a shorter length of stay (LOS) compared to those who received warfarin. However, these trials had strict inclusion and exclusion criteria, and were designed for a different primary outcome. Also, data from these closely monitored clinical trials may not reflect the daily practice of medicine.

Objectives

To clarify this issue further, we performed a retrospective analysis at our institution, comparing the LOS between patients discharged on rivaroxaban and other conventional anticoagulants (warfarin, enoxaparin, and enoxaparin with warfarin).

Methods

This was a retrospective study of consecutive patients admitted to our institution from January 2011 to July 2014 with newly diagnosed venous thromboembolism (VTE). Inclusion criteria were age > 18 years and objective confirmation of VTE. Exclusion criteria included diagnosis of VTE 24 h after admission, contraindication to anticoagulation, treatment with fibrinolytic agents, patients already on anticoagulation, and pregnancy. Out of 1553 consecutive patients diagnosed with VTE, a total of 414 patients met the eligibility criteria. These patients were further subdivided into four groups based on their discharge anticoagulant: rivaroxaban, warfarin, enoxaparin, and warfarin with enoxaparin.

Results

Patients discharged on rivaroxaban had a significantly shorter LOS compared with patients discharged on warfarin (3.5 vs. 7.0 days; p < 0.001), but not when compared to those discharged on enoxaparin alone (3.0 days) or enoxaparin with warfarin (4.0 days) (p > 0.05). The hospital incidence of bleeding and the 6-month readmission rates were not different among the different anticoagulants.

Conclusions

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.

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Author Contribution

All the authors contributed equally towards the design of the study, performance of the study, analysis of the data, and writing the manuscript.

Funding

No external sources of support were used in the completion of this research.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Winthrop-University Hospital, 222 Station Plaza North, Suite 400, Mineola, NY, 11501, USA

    Anish Desai MD, Malaygiri Aparnath, Steve Salzman & Joseph P. Mathew

  2. Division of Hematology & Oncology, Winthrop-University Hospital, 200, Old Country Road, # 450, Mineola, NY, 11501, USA

    Amishi Desai & Alexander Hindenburg

  3. Department of Biostatistics, Winthrop-University Hospital, 222, Station Plaza North, Suite 300, Mineola, NY, 11501, USA

    Rose Calixte

Authors
  1. Anish Desai MD
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  2. Amishi Desai
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  3. Rose Calixte
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  4. Malaygiri Aparnath
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  5. Alexander Hindenburg
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  6. Steve Salzman
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  7. Joseph P. Mathew
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Correspondence to Anish Desai MD.

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Desai, A., Desai, A., Calixte, R. et al. Comparing Length of Stay Between Patients Taking Rivaroxaban and Conventional Anticoagulants for Treatment of Venous Thromboembolism. Lung 194, 605–611 (2016). https://doi.org/10.1007/s00408-016-9898-8

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  • DOI: https://doi.org/10.1007/s00408-016-9898-8

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