title: Shortened length of hospital stay with rivaroxaban in patients with symptomatic venous thromboembolism in Japan: the J-EINSTEIN pulmonary embolism and deep vein thrombosis program.
abstract: BACKGROUND
  In Japan, the standard of care for the treatment of pulmonary embolism (PE) and/or deep vein thrombosis (DVT) consists of intravenous unfractionated heparin (UFH) followed by warfarin, which was recently compared with rivaroxaban, an oral factor Xa inhibitor, in randomized trials.
  
  
  OBJECTIVE
  To examine the length of hospital stay in patients with PE and/or DVT receiving rivaroxaban compared to Japanese standard therapy in the Japanese (J)-EINSTEIN PE and DVT program.
  
  
  METHODS
  Open-label, randomized clinical trials that compared 3, 6, or 12 months of rivaroxaban with UFH and warfarin in patients with acute, confirmed symptomatic proximal PE and/or DVT. Decisions regarding hospital admission and/or discharge were left to the clinical judgment of attending physicians. Analyses were conducted in the intention-to-treat (ITT) population.
  
  
  RESULTS
  In the ITT population (N = 97), overall patient characteristics were similar in both treatment arms. The median length of stay in rivaroxaban patients was 10.0 days (interquartile range [IQR] 6.0 to 15.0 days) while it was 15.0 days (IQR 9.0 to 22.0) for patients on standard therapy (p = 0.016). All of the four DVT patients who were not hospitalized for the index event were in the rivaroxaban arm.
  
  
  CONCLUSIONS
  Our results suggest that treatment with rivaroxaban may significantly reduce the length of hospital stay in patients hospitalized for PE and/or DVT compared with the current standard of care in Japan, thereby reducing the burden on patients and the healthcare system. The limitations of our study include small sample size and the generalizability of the findings to the real-world setting. Further research is warranted to identify PE and/or DVT patients in Japanese clinical practice who may potentially be managed as outpatients.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT01516814 and NCT01516840.
authors: Matsuo Clinic , Osaka , Japan .
authors: Hiroshi
authors: H
authors: Matsuo
authors: Martin
authors: M
authors: Prins
authors: Anthonie W A
authors: AW
authors: Lensing
authors: Emi Watanabe
authors: EW
authors: Fujinuma
authors: Yuki
authors: Y
authors: Miyamoto
authors: Mariko
authors: M
authors: Kajikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D044466:Asian People; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000188:drug therapy*; D000069552:Rivaroxaban / Q000627:therapeutic use*; D054556:Venous Thromboembolism / Q000188:drug therapy; D020246:Venous Thrombosis / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin; D000069552:Rivaroxaban
keywords: Deep vein thrombosis; Japan; Length of stay; Pulmonary embolism; Randomized trial; Rivaroxaban; Unfractionated heparin; Venous thromboembolism; Warfarin