Impact of warfarin vs. novel oral anticoagulants on hospital length of stay in patients with chronic kidney disease Rita Jebrin, PharmD; Allison Wilson, PharmD; David Putney, PharmD, MPH; Meghan McComb, PharmD PURPOSE
RESULTS
Hospital length of stay (LOS) can be prolonged in patients with renal insufficiency due to bleeding and thromboembolic complications during anticoagulant therapy. Warfarin has been the staple treatment in this patient population, but novel oral anticoagulants (NOACs) provide an appealing alternative to warfarin due to minimal monitoring requirements. Yet, the impact of renal insufficiency on clinical outcomes in patients receiving NOACs has not been clearly elucidated.
Overall, hospital LOS was significantly shorter in patients who were receiving one of the NOACs than in those who were receiving warfarin therapy (10 days versus 18 days, respectively; p <0.01). During treatment, new thromboembolic event occurred in 4 patients in the NOAC group and 10 patients in the warfarin group (p= 0.2). Major bleeding events occurred in 3 patients during NOACs therapy and in 5 patients during warfarin therapy (p= 0.5). Death due to a bleeding event occurred in 1 patient in each treatment group.
METHODS
A single center, retrospective cohort analysis was conducted among patients 18 years of age or older. A total of 200 chronic kidney disease (CKD) patients who were receiving warfarin therapy or one of the NOACs (apixaban, dabigatran, and rivaroxaban) for stroke prophylaxis in atrial fibrillation, or for the treatment of deep vein thrombosis, or pulmonary embolism were included in the study. The primary outcome was hospital LOS in each treatment group. Secondary outcomes include new thromboembolic or bleeding events, death during hospitalization, and hospital readmissions within 90 days of discharge.
CONCLUSION
In conclusion, NOAC therapy was associated with a shorter hospital LOS and comparable efficacy and safety outcomes compared to warfarin therapy in patients with CKD stage III-IV including dialysis patients.
PGY1 PHARMACY RESIDENCY
Rita Jebrin, PharmD Rita earned her Doctor of Pharmacy from Jordan University of Science and Technology in 2013. Then she moved to the United States and completed her pharmacy internship at Houston Methodist Hospital. Following completion of her residency, Rita will move to Abu Dhabi for an ambulatory clinical pharmacist position at Cleveland Clinic. Primary project preceptor: Allison Wilson, PharmD, BCPS Presented at 2016 Midwest Pharmacy Residents Conference, Omaha, Neb.
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