Weeda Erin R, Peacock W Frank, Fermann Gregory J, Baugh Christopher W, Wells Philip S, Ashton Veronica, Crivera Concetta, Wildgoose Peter, Schein Jeff R, Coleman Craig I
University of Connecticut School of Pharmacy, Storrs, CT, USA.
Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
Int J Clin Pract. 2017 Jan;71(1). doi: 10.1111/ijcp.12915.
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.
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.
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.
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.
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.
与利伐沙班不同，对华法林治疗的肺栓塞（PE）患者需要肠外桥接和凝血监测，这可能会延长住院时间（LOS）并增加医院成本。
本研究的目的是比较通过观察住院接受利伐沙班治疗或肠外桥接华法林治疗的PE患者的住院时间、医院成本和再入院情况。
使用2012年11月至2015年3月的Premier医院索赔数据，确定通过观察住院治疗且在第0 - 2天有≥1次PE相关诊断测试索赔的原发性诊断代码为PE的患者。允许≤2天先前肠外治疗的利伐沙班使用者与接受肠外桥接华法林治疗的患者进行1:1倾向评分匹配。使用多变量回归比较匹配队列之间的住院时间、持续超过2个午夜的就诊比例、首次就诊的总医院成本以及在首次事件后同一个月或随后2个月内静脉血栓栓塞（VTE）或大出血的再入院风险。
共有312名利伐沙班使用者与312名接受肠外桥接华法林治疗的患者相匹配。与肠外桥接华法林相比，利伐沙班使平均住院时间缩短0.27天，持续超过2个午夜的就诊几率降低52%，平均成本降低403美元（所有P≤0.002）。首次PE后同一个月或随后2个月内VTE的再入院率在队列之间相似（P = 0.75）。两个队列中均无患者因大出血再次入院。
在PE观察住院患者中，与肠外桥接华法林相比，利伐沙班可缩短住院时间并降低成本，且不增加短期并发症或再入院率。
