scholarly journals Outpatient treatment in low-risk pulmonary embolism patients receiving direct acting oral anticoagulants is associated with cost savings.

2020 ◽  
Author(s):  
Raein Ghazvinian ◽  
Johan Elf ◽  
Anders Gottsäter ◽  
Sofie Löfvendahl ◽  
Jan Holst
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cost Savings ◽  
Low Risk ◽  
Potential Cost ◽  
Multicenter Cohort Study ◽  
Total Cost ◽  
Outpatient Group

Abstract Background Direct oral anticoagulants (DOAC) are first line treatment for pulmonary embolism (PE). Treatment of acute PE is traditionally hospital based and associated with high costs, in spite of recent guidelines suggesting outpatient treatment for low-risk patients. The aims of this study were to evaluate potential cost savings with outpatient DOAC treatment of patients with low risk PE compared to DOAC treatment of low risk PE patients in hospital. Methods A retrospective comparatory multicenter cohort study in patients with low risk PE (simplified pulmonary severity index [sPESI]) ≤ 1 admitted to the eight hospitals in Sweden´s southernmost healthcare region during 2013-2015, and treated with DOAC. Local criteria guiding outpatient treatment had been used, and sPESI was calculated retrospectively. Health care costs were analysed in the 223 (44%) patients treated as outpatients and the 287 (56%) treated in hospital. Results Total cost per patient was 7334 EUR in the inpatient group, and 2088 EUR in the outpatient group (p<0.001). In multivariate analysis, type of treatment (in- or outpatient, p=<0.001) and sPESI group (0 or 1, p=<0.001) were significantly associated with total cost below or above median, whereas age (p=0.565) and gender (p=0.177) was not. Total cost for inpatients was higher (p<0.001) compared to outpatients in subgroups with sPESI 0 and 1. Conclusion Better adherence to current guidelines recommending outpatient treatment with DOAC in patients with low risk PE would potentially lead to significant savings in healthcare expenditure.

scholarly journals Outpatient Treatment in Low-Risk Pulmonary Embolism Patients Receiving Direct Acting Oral Anticoagulants Is Associated With Cost Savings

2020 ◽  
Vol 26 ◽  
pp. 107602962093735
Author(s):  
Raein Ghazvinian ◽  
Johan Elf ◽  
Sofia Löfvendahl ◽  
Jan Holst ◽  
Anders Gottsäter
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cost Savings ◽  
Severity Index ◽  
Low Risk ◽  
Potential Cost ◽  
Total Cost ◽  
Outpatient Group

Direct oral anticoagulants (DOAC) are first line treatment for pulmonary embolism (PE). Treatment of acute PE is traditionally hospital based and associated with high costs. The aims of this study were to evaluate potential cost savings with outpatient DOAC treatment compared to inpatient DOAC treatment in patients with low risk PE. A retrospective study in patients with DOAC treated low risk PE (simplified pulmonary severity index [sPESI] ≤ 1) admitted to 8 hospitals during 2013-2015. Health care costs were compared in 223(44%) patients treated as outpatients and 287(56%) treated in hospital. Total cost per patient was 8293 EUR in the inpatient group, and 2176 EUR in the outpatient group (p < 0.001). Total costs for inpatients were higher (p < 0.001) compared to outpatients in both subgroups with sPESI 0 and 1. In multivariate analysis, type of treatment (in- or outpatient, p = < 0.001) and sPESI group (0 or 1, p = < 0.001) were associated with total cost below or above median, whereas age (p = 0.565) and gender (p = 0.177) was not. Adherence to guidelines recommending outpatient treatment with DOAC in patients with low risk PE enables significant savings.

scholarly journals Assessment of Utilization of Outpatient Based Treatment for Low Risk Patients with Pulmonary Embolism in Two Community Teaching Hospitals

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5779-5779
Author(s):  
Kavita Agrawal ◽  
Nirav Agrawal ◽  
Harsha Adnani ◽  
Anjali Kakwani
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Inpatient Treatment ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
Low Risk ◽  
Teaching Hospitals ◽  
Outpatient Basis ◽  
Community Hospitals ◽  
Risk Patients

OBJECTIVE: Several randomized controlled trials and meta-analysis has proven safety and efficacy of outpatient based treatment in appropriately selected low-risk patients with pulmonary embolism (PE). Despite the fact that outpatient treatment has been proven safe, prior studies have shown that it is not commonly practiced. Our current multi-center study focuses on identifying practices of outpatient versus inpatient treatment of low risk PE patients in two community hospitals between 2018-2019. METHODS: A retrospective chart review of the patients in two community hospitals with the principal discharge diagnosis of pulmonary embolism aged 18 years or older was conducted. The study period included February 2018 to February 2019. The high risk patients defined as simplified pulmonary embolism severity index (PESI) score of 1 or above were excluded from the study. Low risk patients were defined as with a simplified PESI score of 0. Criteria were established to determine the appropriateness of inpatient admission for low risk patients with PE. The group of low risk patients with thrombocytopenia (platelets less than 70,000/mm3), glomerular filtration rate (GFR) of less than 30 ml/ minute, international normalized ratio (INR) greater than 1.5, pregnancy, active bleeding as documented in the medical records, total bilirubin greater than 3.0 mg/dl, extreme obesity (weight greater than 150 kg), diagnosis of acute PE while on oral anticoagulation, requiring narcotics for chest pain, need for supplemental oxygen , poor social support or presence of concomitant extensive deep vein thrombosis were deemed appropriate for inpatient treatment. The patients without these baseline characteristics were considered appropriate for outpatient treatment. RESULTS: The cohort comprised of 442 patients in two community hospitals. Among these, 172 patients had a simplified PESI score of 1 or above and were excluded from the study. The remaining 270 patients had a simplified PESI score of 0 and were considered low risk. Based on the study criteria, 54% (145 patients out of 270) of the low risk patients were deemed appropriate for outpatient treatment. Out of these, only 16% (23 patients out of 145) were treated at home. The remaining 84% (122 patients out of 145) of the low risk PE patients considered safe for outpatient treatment were actually treated as inpatient. The mean length of hospital stay for this group of patients was 3 days. Anti-coagulation therapy for those treated on outpatient basis was novel oral anticoagulants in 79% (18 patients out of 23) and low molecular weight heparin or warfarin in 21% (5 patients out of 23). CONCLUSION: Our study demonstrates that majority of low risk PE patients deemed appropriate for outpatient based treatment are treated on inpatient basis. This study shows that there is a need to implement interventions to improve practices of outpatient management of appropriately selected low-risk PE patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Risk stratification and management of acute pulmonary embolism

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 404-412 ◽  
Author(s):  
Cecilia Becattini ◽  
Giancarlo Agnelli
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Clinical Management ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Management Strategies ◽  
Vena Cava ◽  
Low Risk ◽  
Bleeding Complications

Abstract The clinical management of patients with acute pulmonary embolism is rapidly changing over the years. The widening spectrum of clinical management strategies for these patients requires effective tools for risk stratification. Patients at low risk for death could be candidates for home treatment or early discharge. Clinical models with high negative predictive value have been validated that could be used to select patients at low risk for death. In a major study and in several meta-analyses, thrombolysis in hemodynamically stable patients was associated with unacceptably high risk for major bleeding complications or intracranial hemorrhage. Thus, the presence of shock or sustained hypotension continues to be the criterion for the selection of candidates for thrombolytic treatment. Interventional procedures for early revascularization should be reserved to selected patients until further evidence is available. No clinical advantage is expected with the insertion of a vena cava filter in the acute-phase management of patients with acute pulmonary embolism. Direct oral anticoagulants used in fixed doses without laboratory monitoring showed similar efficacy (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.70-1.12) and safety (OR, 0.89; 95% CI, 0.77-1.03) in comparison with conventional anticoagulation in patients with acute pulmonary embolism. Based on these results and on their practicality, direct oral anticoagulants are the agents of choice for the treatment of the majority of patients with acute pulmonary embolism.

scholarly journals Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism

2017 ◽  
Vol 36 (11) ◽  
pp. 801-806
Author(s):  
Sónia Martins Santos ◽  
Susana Cunha ◽  
Rui Baptista ◽  
Sílvia Monteiro ◽  
Pedro Monteiro ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Real World ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants

scholarly journals Treatment of Pulmonary Embolism: a Decade of Experience

2019 ◽  
pp. 46-49
Author(s):  
A. Nikonenko ◽  
A. Nikonenko ◽  
S. Matvieiev ◽  
V. Osaulenko ◽  
S. Nakonechniy
Keyword(s):  
Pulmonary Embolism ◽  
Outpatient Treatment ◽  
Acute Pulmonary Embolism ◽  
High Efficiency ◽  
Oral Anticoagulants ◽  
Fibrinolytic Therapy ◽  
Major Life ◽  
Life Threatening Illness ◽  
The World ◽  
Life Threatening

Pulmonary embolism (PE) is a major life-threatening illness which remains one of the main causes of sudden death throughout the world. The analysis of diagnosis and treatment of 472 patients with acute pulmonary embolism for a period of 10 years was performed. High efficiency of diagnosis using multispiral computer angiopulmonography (MSCT APG) has been established, thus this method completely supersedes the traditional selective angiopulmonography. Seventeen (3.6 %) patients died due to PE recurrence, another 8 (1.7 %) patients died due to the bleeding after using fibrinolytics and anticoagulants, and 14 (2.9 %) died due to progression of organs failure. This emphasizes the need to improve measures aimed to prevent PE recurrence and identify sources of possible bleeding and refrain from aggressive fibrinolytic therapy. The use of differentiated approach to the treatment with thrombolytic therapy and anticoagulants enabled to achieve recovery in 433 (91.7 %) patients who were discharged for outpatient treatment. New oral anticoagulants were prescribed to 94 (21.7 %) patients after discharge.

Direct oral anticoagulants for therapeutic anticoagulation in postoperative pulmonary embolism after meningioma resection

2020 ◽  
Vol 81 ◽  
pp. 265-269
Author(s):  
Daniel Dubinski ◽  
Sae-Yeon Won ◽  
Wolfgang Miesbach ◽  
Fee Keil ◽  
Bedjan Behmanesh ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Therapeutic Anticoagulation

scholarly journals Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism

2017 ◽  
Vol 36 (11) ◽  
pp. 801-806 ◽  
Author(s):  
Sónia Martins Santos ◽  
Susana Cunha ◽  
Rui Baptista ◽  
Sílvia Monteiro ◽  
Pedro Monteiro ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Real World ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants

scholarly journals Dabigatran after Short Heparin Anticoagulation for Acute Intermediate-Risk Pulmonary Embolism: Rationale and Design of the Single-Arm PEITHO-2 Study

2017 ◽  
Vol 117 (12) ◽  
pp. 2425-2434 ◽  
Author(s):  
Frederikus Klok ◽  
Walter Ageno ◽  
Stefano Barco ◽  
Harald Binder ◽  
Benjamin Brenner ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Phase Iii ◽  
Thrombin Inhibitor ◽  
Intermediate Risk ◽  
Safety Outcome ◽  
Efficacy Outcome ◽  
Heparin Anticoagulation

AbstractPatients with intermediate-risk pulmonary embolism (PE) may, depending on the method and cut-off values used for definition, account for up to 60% of all patients with PE and have an 8% or higher risk of short-term adverse outcome. Although four non-vitamin K-dependent direct oral anticoagulants (NOACs) have been approved for the treatment of venous thromboembolism, their safety and efficacy as well as the optimal anticoagulation regimen using these drugs have not been systematically investigated in intermediate-risk PE. Moreover, it remains unknown how many patients with intermediate-high-risk and intermediate-low-risk PE were included in most of the phase III NOAC trials. The ongoing Pulmonary Embolism International Thrombolysis 2 (PEITHO-2) study is a prospective, multicentre, multinational, single-arm trial investigating whether treatment of acute intermediate-risk PE with parenteral heparin anticoagulation over the first 72 hours, followed by the direct oral thrombin inhibitor dabigatran over 6 months, is effective and safe. The primary efficacy outcome is recurrent symptomatic venous thromboembolism or death related to PE within the first 6 months. The primary safety outcome is major bleeding as defined by the International Society on Thrombosis and Haemostasis. Secondary outcomes include all-cause mortality, the overall duration of hospital stay (index event and repeated hospitalizations) and the temporal pattern of recovery of right ventricular function over the 6-month follow-up period. By applying and evaluating a contemporary risk-tailored treatment strategy for acute PE, PEITHO-2 will implement the recommendations of current guidelines and contribute to their further evolution.

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