Comparison of inpatient admission rates of patients treated with apixaban vs. warfarin for venous thromboembolism in the emergency department
- 1 January 2020
- journal article
- research article
- Published by Taylor & Francis Ltd in Hospital Practice
- Vol. 48 (1), 41-48
- https://doi.org/10.1080/21548331.2020.1718925
Abstract
Objectives: This study evaluated inpatient admission status, hospitalization length of stay (LOS), hospital costs, and readmissions of patients who were diagnosed with venous thromboembolism (VTE) and treated with apixaban or warfarin in the emergency department (ED).Methods: Patients (≥18 years) with an ED visit with a primary discharge diagnosis code of VTE were identified from the Premier Hospital database (8/1/2014-5/31/2018). Patients who received apixaban or warfarin during the ED visit were selected and grouped into two treatment cohorts. Outcomes of ED disposition (discharged or admitted to the inpatient setting), hospital LOS, hospital cost of index event, and rate of 1-month readmissions were compared for the study cohorts.Results: Of the overall study population, 30.5% (n = 12,174; mean age: 59.7 years) received apixaban and 69.5% (n = 27,767; mean age: 59.3 years) received warfarin for VTE in the ED. After adjusting for patient and hospital characteristics, the regression analysis showed that apixaban was associated with a significantly lower likelihood of admission to the inpatient setting vs. warfarin (Odds Ratio [OR]: 0.12, 95% Confidence Interval [CI]: 0.12 to 0.13; p < 0.001). Correspondingly, mean index hospital LOS was 1.42 days shorter (95% CI: -1.47 to -1.36; p < 0.001) and mean index event hospital cost per patient was significantly lower by $4,276 ($3,732 [95% CI: $3,565 to $3,907] vs. $8,008 [95% CI: $7,676 to $8,355]; p < 0.001). Also, the likelihood of all-cause 1-month readmission was significantly lower for patients treated with apixaban vs. warfarin (OR: 0.85, 95% CI: 0.79 to 0.92; p < 0.001).Conclusions: In the real-world setting, VTE patients with an ED visit who were treated with apixaban vs. warfarin had a lower likelihood of being admitted to the inpatient setting, which was reflected in shorter average LOS and lower average index event cost. Additionally, the risk of 1-month readmission was also lower for patients treated with apixaban vs. warfarin.Keywords
This publication has 23 references indexed in Scilit:
- Hospital Resource Utilization and Costs Associated With Warfarin Versus Apixaban Treatment Among Patients Hospitalized for Venous Thromboembolism in the United StatesClinical and Applied Thrombosis/hemostasis, 2018
- National trends in hospitalizations for venous thromboembolismJournal of Vascular Surgery. Venous and Lymphatic Disorders, 2017
- Antithrombotic Therapy for VTE DiseaseSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2016
- Epidemiology of venous thromboembolismNature Reviews Cardiology, 2015
- Real-World Medical Cost Avoidance When New Oral Anticoagulants are Used Versus Warfarin for Venous Thromboembolism in the United StatesClinical and Applied Thrombosis/hemostasis, 2015
- Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice GuidelinesSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- Venous thromboembolism: Annualised United States models for total, hospital-acquired and preventable costs utilising long-term attack ratesThrombosis and Haemostasis, 2012
- Prevalence of clinical venous thromboembolism in the USA: Current trends and future projectionsAmerican Journal of Hematology, 2010
- Venous Thromboembolism: A Public Health ConcernAmerican Journal of Preventive Medicine, 2010
- Dabigatran versus Warfarin in the Treatment of Acute Venous ThromboembolismThe New England Journal of Medicine, 2009