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ASHP: Reducing Hospital Readmission among NVAF and VTE Patients on Anticoagulants


December 11, 2015

NEW ORLEANS, Louisiana – When it comes to anticoagulation use for patients with non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE), there is room for improvement. 

The aim of a retrospective analysis  presented at the midyear meeting of the American Society of Health-System Pharmacists was to examine readmission rates at St. Joseph Mercy Oakland (SJMO) for patients, ages 18 and older, taking warfarin or one of the direct oral anticoagulants – apixaban, dabigatran, and rivaroxaban – for either NVAF, VTE, or both.

Of the 58 patients studied, 59.3% were female. The breakdown of patients on each of the drugs is as follows: warfarin (28); apixaban (13); and rivaroxaban (17). Although the study set out to observe dabigatran use, no patients taking the medication were included.

"I suspect there were no patients initiated on dabigatran because of the adverse bleeding events (such as GI bleeds) which are associated with the drug," study author Dr. Kelly DeJager said.

Hospital readmission occurred with all three anticoagulants, the study authors noted. The percentages of readmission per drug are as follows:

  • 41% of patients taking rivaroxaban;
  • 36% of patients on warfarin;
  • 15% of patients taking apixaban.

Of the two patients taking apixaban who were readmitted, one experienced a cardioembolic stroke. Of the seven patients taking rivaroxaban who were readmitted, one was readmitted for bleeding. Of the 10 patients taking warfarin who were readmitted, six were readmitted for various types of bleeding, including mouth, rectal bleeding, gastrointestinal bleeding, and hematuria.

"The study was designed to observe readmission rates so I did not expect to see more readmission for one agent versus the other initially," Dr. DeJager said. "Although, most patients were initiated on warfarin vs.  the other agents, so you might see more patients return just because it was a larger sample size." 

The study authors noted, “There is opportunity to improve the discharge instructions when patients are discharged on oral anticoagulation for atrial fibrillation and VTE treatment.”

They also found an opportunity to improve apixaban dosing based on age, weight, and serum creatinine.

The authors of the study had nothing to disclose.

The results of the study were presented during the resident poster session at the midyear meeting in New Orleans.

 

--Stephanie Vaccaro

 

Reference:

1. DeJager K, Valone R, Lambart E. Evaluation of rivaroxaban, apixaban, dabigatran, and warfarin on hospital readmission rates following initiation of medication for non-valvular atrial fibrillation and venous thromboembolism (VTE). Presented at: 50th Midyear meeting of the American Society of Health-System Pharmacists. December 9, 2015; New Orleans, LA. Poster presentation.

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