Laliberté François, Pilon Dominic, Raut Monika K, Nelson Winnie W, Olson William H, Germain Guillaume, Schein Jeff R, Lefebvre Patrick
Groupe d'analyse , Ltée, Montréal, QC , Canada.
Curr Med Res Opin. 2014 Apr;30(4):645-53. doi: 10.1185/03007995.2013.867843. Epub 2013 Dec 5.
Warfarin has been the mainstay treatment for prevention of stroke among patients with non-valvular atrial fibrillation (NVAF). Unlike rivaroxaban, warfarin requires laboratory monitoring to allow the attainment of the prothrombin time (PT) international normalized ratio (INR) goal, thereby potentially prolonging a patient's hospital length of stay (LOS).
To compare hospital LOS between hospitalized NVAF patients using rivaroxaban versus warfarin in a real-world setting.
A retrospective claims analysis was conducted using the Premier Perspective Comparative Hospital Database from 11/2010 to 9/2012. Adult patients were included in the study if they had a hospitalization for NVAF. Patients using rivaroxaban during hospitalization were matched with up to four warfarin users by propensity score analyses. Patients who were first administered their oral anticoagulants on day 3 or later of their hospital stay were also evaluated. Comparison of hospital LOS was assessed using generalized estimating equations.
The characteristics of the matched cohorts were well balanced. Among the matched rivaroxaban and warfarin users (2809 and 11,085 patients, respectively), the mean age of the cohorts was 71 years and 49% of patients were female. The average (median) hospital LOS for rivaroxaban patients was 4.46 (3) days, compared to 5.27 (4) days for the warfarin cohort. The mean difference in hospital LOS of 0.81 days (19.44 hours) was found to be significant at P < 0.001. Patients who were administered rivaroxaban on day 3 of their hospital stay or later also had a significantly lower LOS compared to warfarin users.
These included inaccuracies or omissions in diagnoses, completeness of baseline characteristics, and a study population that included patients newly initiated on and patients who continued anticoagulant therapy.
The study sample of NVAF patients receiving rivaroxaban was associated with a significantly shorter hospital length of stay compared to the sample of patients receiving warfarin.
华法林一直是预防非瓣膜性心房颤动（NVAF）患者中风的主要治疗方法。与利伐沙班不同，华法林需要实验室监测以达到凝血酶原时间（PT）国际标准化比值（INR）目标，从而可能延长患者的住院时间（LOS）。
在实际临床环境中比较使用利伐沙班与华法林的住院NVAF患者的住院时间。
使用Premier Perspective Comparative Hospital Database对2010年11月至2012年9月的数据进行回顾性索赔分析。纳入因NVAF住院的成年患者。通过倾向评分分析，将住院期间使用利伐沙班的患者与最多四名使用华法林的患者进行匹配。还对在住院第3天或更晚开始首次口服抗凝剂的患者进行了评估。使用广义估计方程评估住院时间的比较。
匹配队列的特征平衡良好。在匹配的利伐沙班和华法林使用者中（分别为2809例和11085例患者），队列的平均年龄为71岁，49%的患者为女性。利伐沙班患者的平均（中位数）住院时间为4.46（3）天，而华法林队列患者为5.27（4）天。住院时间的平均差异为0.81天（19.44小时），在P < 0.001时具有显著意义。在住院第3天或更晚开始使用利伐沙班的患者与华法林使用者相比，住院时间也显著缩短。
这些局限性包括诊断中的不准确或遗漏、基线特征的完整性，以及研究人群包括新开始和继续接受抗凝治疗的患者。
与接受华法林治疗的患者样本相比，接受利伐沙班治疗的NVAF患者研究样本的住院时间显著缩短。
