title: Comparing Length of Stay Between Patients Taking Rivaroxaban and Conventional Anticoagulants for Treatment of Venous Thromboembolism.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Winthrop-University Hospital, 222 Station Plaza North, Suite 400, Mineola, NY, 11501, USA. anish1desai@yahoo.com.
authors.forename: Anish
authors.initials: A
authors.lastname: Desai
authors.affiliation: Division of Hematology & Oncology, Winthrop-University Hospital, 200, Old Country Road, # 450, Mineola, NY, 11501, USA.
authors.forename: Amishi
authors.initials: A
authors.lastname: Desai
authors.affiliation: Department of Biostatistics, Winthrop-University Hospital, 222, Station Plaza North, Suite 300, Mineola, NY, 11501, USA.
authors.forename: Rose
authors.initials: R
authors.lastname: Calixte
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Winthrop-University Hospital, 222 Station Plaza North, Suite 400, Mineola, NY, 11501, USA.
authors.forename: Malaygiri
authors.initials: M
authors.lastname: Aparnath
authors.affiliation: Division of Hematology & Oncology, Winthrop-University Hospital, 200, Old Country Road, # 450, Mineola, NY, 11501, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hindenburg
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Winthrop-University Hospital, 222 Station Plaza North, Suite 400, Mineola, NY, 11501, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Salzman
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Winthrop-University Hospital, 222 Station Plaza North, Suite 400, Mineola, NY, 11501, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Mathew
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000627:therapeutic use; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000009:adverse effects / Q000627:therapeutic use*; D054556:Venous Thromboembolism / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D065427:Factor Xa Inhibitors; D014859:Warfarin; D000069552:Rivaroxaban
keywords: Length of stay; Rivaroxaban; Venous thromboembolism; Warfarin