Key result
Apixaban treatment in the emergency department for venous thromboembolism was associated with a significantly lower likelihood of inpatient admission compared to warfarin (OR 0.12; 95% CI 0.12-0.13).
Why the study?
The study evaluated inpatient admission status, length of stay, costs, and readmissions among patients diagnosed with venous thromboembolism and treated with apixaban or warfarin in the emergency department.
Does apixaban reduce inpatient admissions compared to warfarin in adult patients presenting to the emergency department with venous thromboembolism?
Cohort (n=39,941)
Yes
Does apixaban reduce inpatient admissions compared to warfarin in adult patients presenting to the emergency department with venous thromboembolism?
Odds Ratio: 0.12 (95% CI 0.12–0.13)
p-value: p=< 0.001
In patients presenting to the emergency department with VTE, treatment with apixaban compared to warfarin is associated with significantly lower rates of inpatient admission, shorter length of stay, and lower costs.
Apixaban was associated with lower VTE admission rates than warfarin in ED; leaves open selection effects or benefits in prospective trials.
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.
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Deitelzweig et al. (2020) conducted a cohort in Venous thromboembolism (VTE) (n=39,941). Apixaban vs. Warfarin was evaluated on Admission to the inpatient setting (OR 0.12, 95% CI 0.12 to 0.13, p=< 0.001). Apixaban treatment in the emergency department for venous thromboembolism was associated with a significantly lower likelihood of inpatient admission compared to warfarin (OR 0.12; 95% CI 0.12-0.13).
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