Association between rivaroxaban use and length of hospital stay, treatment costs and early outcomes in patients with pulmonary embolism: a systematic review of real-world studies.
Curr Med Res Opin. 2017 Jun 30;:1-16
Authors: Kohn CG, Fermann GJ, Peacock WF, Wells PS, Baugh CW, Ashton V, Crivera C, Schein JR, Wildgoose P, Coleman CI
BACKGROUND: In the EINSTEIN-Pulmonary Embolism (PE) trial, subjects randomized to rivaroxaban versus enoxaparin-bridging to vitamin K antagonist (VKA) therapy experienced a reduced index hospital length-of-stay (LOS). We sought to conduct a systematic review of real-world studies comparing LOS, costs and early outcomes among patients treated with rivaroxaban or parenterally-bridged VKA in routine practice.
METHODS: We searched Medline and Scopus from 1/1/2011-11/30/2016 to identify observational studies comparing acute PE patients anticoagulated with rivaroxaban or parenterally-bridged VKA and reporting data on index hospital LOS, costs and/or early post-PE outcomes. Studies not using appropriate methods for minimizing confounding bias or not published in English were excluded.
RESULTS: Five studies met inclusion criteria. Rivaroxaban use was associated with decreased index hospital LOS (range: 1.36-1.70 days) and treatment costs (range: $1,818-$2,688) during an index stay compared to parenterally-bridged warfarin. No differences in early readmission for recurrent thrombosis were noted between anticoagulation strategies. Readmission for major bleeding was rare in both cohorts. Similar reductions in LOS (range: 0.23-4.3 days) and costs (range: $251-$7,094) were observed with rivaroxaban in studies restricted to patients deemed low-risk for early complications by clinical gestalt or by a clinical- or claims-based risk stratification tool.
CONCLUSIONS: Regardless of patient predicted risk of post-PE complications, real-world studies suggest rivaroxaban is associated with a reduced hospital LOS and costs versus parenterally-bridged warfarin, without increasing readmission.
PMID: 28665208 [PubMed - as supplied by publisher]