Photo courtesy of the CDC
Patients admitted to the emergency department (ED) for venous thromboembolism (VTE) can be placed on oral anticoagulation and discharged immediately, according to research published in Academic Emergency Medicine.
The study showed that patients who received anticoagulation with rivaroxaban, were discharged from the ED right away, and did not undergo weekly monitoring had a low rate of VTE recurrence and major or clinically relevant bleeding.
A related study suggested this approach was less costly than standard treatment with heparin and warfarin.
The prospect of being able to send patients home from the ED on the day of admission is a quality of life issue, according to Jeffrey A. Kline, MD, a professor at the Indiana University School of Medicine in Indianapolis and an author of both studies.
“We really do empower the patient more with [rivaroxaban],” he said. “Patients say treatment with no injections is a much better option. [Rivaroxaban] takes a condition that is life-threatening and makes it something the patient can control.”
Safety and efficacy
For the first study, Dr Kline and his colleagues evaluated 106 low-risk patients who were diagnosed with deep vein thrombosis (DVT) or pulmonary embolism (PE) at 2 metropolitan EDs.
The patients were admitted between March 2013 and April 2014. Seventy-one patients had DVT, 30 had PE, and 5 had both.
The standard of care for these patients is heparin injections, followed by oral warfarin and close monitoring to ensure safe dosage levels.
But patients in this study received rivaroxaban, which does not require blood monitoring, and were released from the hospital on the day of admission. The patients did undergo follow up-monitoring at 2 weeks, 5 weeks, 3 months, and 6 months.
The researchers followed patients for a mean of 389 days (range, 213 to 594 days). None of the patients had a VTE recurrence, major bleeding, or clinically relevant bleeding while on therapy.
However, 3 patients (2.8%) experienced DVT recurrence within a year of stopping treatment. All 3 had completed their prescribed treatment.
“This study is about giving patients a new option,” Dr Kline said. “Treating patients at home for blood clots was found to have fewer errors than the standard of care and better outcomes. Patients [receiving standard therapy] have to be taught to give themselves injections, and it scares them to death. Almost everyone has taken a pill, so there is no learning curve for patients [with rivaroxaban].”
Treatment costs
In the second study, Dr Kline and his colleagues compared costs associated with standard treatment and rivaroxaban. Total hospital charges with the rivaroxaban protocol were about half the cost of charges for standard therapy.
The researchers evaluated 97 patients, matching them for age, sex, and the severity of their illness. At 6 months after ED admission, the median cost was $4787 (interquartile range=$3042 to $7596) for the rivaroxaban group and $11,128 (interquartile range=$8110 to $23,390) for the group treated with standard care (P<0.001).
Among patients with PE, costs were 57% lower in the rivaroxaban group than the standard therapy group (P<0.001). For patients with DVT, costs were 56% lower in the rivaroxaban group (P=0.003).
