title: Shortened hospital length of stay and lower costs associated with rivaroxaban in patients with pulmonary embolism managed as observation status.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Connecticut School of Pharmacy, Storrs, CT, USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Weeda
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
authors.affiliation: Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baugh
authors.affiliation: Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Veronica
authors.initials: V
authors.lastname: Ashton
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Concetta
authors.initials: C
authors.lastname: Crivera
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Wildgoose
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Schein
authors.affiliation: University of Connecticut School of Pharmacy, Storrs, CT, USA.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
mesh_terms: D000067575:Administrative Claims, Healthcare; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D019370:Observation; D010359:Patient Readmission / Q000706:statistics & numerical data*; D057216:Propensity Score; D011655:Pulmonary Embolism / Q000628:therapy*; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D054556:Venous Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069552:Rivaroxaban
keywords: length-of-stay; parenteral bridging; pulmonary embolism; rivaroxaban; thromboembolism; venous