Shortened hospital length of stay and lower costs associated with rivaroxaban in patients with pulmonary embolism managed as observation status

Int J Clin Pract. 2017 Jan;71(1). doi: 10.1111/ijcp.12915.


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.

Aims: 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.

Conclusion: 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.

Keywords: length-of-stay; parenteral bridging; pulmonary embolism; rivaroxaban; thromboembolism; venous.

MeSH terms

  • Administrative Claims, Healthcare
  • Adult
  • Aged
  • Anticoagulants / economics
  • Anticoagulants / therapeutic use*
  • Female
  • Hemorrhage / chemically induced
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Length of Stay / economics*
  • Male
  • Middle Aged
  • Observation
  • Patient Readmission / statistics & numerical data*
  • Propensity Score
  • Pulmonary Embolism / therapy*
  • Rivaroxaban / administration & dosage
  • Rivaroxaban / economics
  • Rivaroxaban / therapeutic use*
  • Venous Thromboembolism / prevention & control
  • Warfarin / economics
  • Warfarin / therapeutic use*


  • Anticoagulants
  • Warfarin
  • Rivaroxaban