Initiation of direct oral anticoagulants versus warfarin for venous thromboembolism: impact on time to hospital discharge.

The objective of this project was to compare the time from initiation of oral anticoagulation to hospital discharge between warfarin and direct oral anticoagulants (DOACs) for the treatment of acute venous thromboembolism (VTE). This retrospective observational study was done at a single VA medical center. A total of 107 patients were included, with 42 patients (39%) in the DOAC group, which included rivaroxaban, dabigatran, and apixaban, and 65 patients (61%) in the warfarin group. Variables collected through chart review included comorbid conditions, time from initiation of oral anticoagulation to discharge, emergency department (ED) visits and readmission within 30 or 90 days, and bleeding events. The DOAC group had a shorter time to discharge compared to the warfarin group (28 vs. 114 h, p < 0.001). There were similar 30 and 90-day hospital readmission rates and/or ED visits for DOACs (23.8 and 33.3%) compared to warfarin (18.5 and 30.8%), including those related to bleeding of any severity (11.9% for DOACs vs. 9.2% for warfarin; p = 0.75). There was one major bleeding event in the DOAC group and two in the warfarin group. The use of DOACs for the treatment of acute VTE in hospitalized patients was associated with shorter time to hospital discharge when compared to warfarin.

Direct Oral Anticoagulants in Cardioversion: A Review of Current Evidence.

OBJECTIVE: Direct oral anticoagulants (DOACs) are recommended for the prevention of stroke or systemic embolism in nonvalvular atrial fibrillation. Dabigatran, rivaroxaban, apixaban, and edoxaban represent possible alternatives to warfarin in the setting of cardioversion. A literature review was conducted to evaluate the safety and efficacy of DOAC use pericardioversion. DATA SOURCES: A PubMed and MEDLINE search through August 2017 was conducted using the following search terms alone or in various combinations: dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban, DOAC, NOAC, TSOAC, cardioversion. STUDY SELECTION AND DATA EXTRACTION: All English-language, human studies comparing the safety and efficacy of DOACs with that of other anticoagulants in the setting of cardioversion were eligible for inclusion. References from published articles were reviewed for additional relevant citations for study inclusion. Four retrospective and 2 prospective trials comparing DOACs with warfarin were identified. DATA SYNTHESIS: The majority of studies included patients undergoing electric cardioversion. Based on current evidence, the DOACs perform similarly to warfarin in the prevention of stroke and systemic embolism, and bleeding rates are comparable. CONCLUSIONS: DOACs may be an attractive alternative to warfarin because of fast onset of action, potentially reducing delay to cardioversion. More robust studies are needed in patients with renal dysfunction and patients undergoing pharmacological cardioversion.

A Comparison Between Dabigatran and Warfarin on Time to Elective Cardioversion.

OBJECTIVE: To evaluate the use of dabigatran versus warfarin on time to elective direct current cardioversion (DCCV). METHODOLOGY: This retrospective observational study was conducted at a single Veterans Affairs hospital in the Southwestern region of the U.S. Patients with atrial fibrillation or atrial flutter who were initiated on either warfarin or dabigatran prior to DCCV were reviewed. The time to cardioversion was compared between warfarin and dabigatran, as well as costs of therapy, rescheduling rates, and adverse events. RESULTS: Out of 258 patients reviewed, a total of 68 patients were included in the study. All patients were male with an average age of 68 years (SD=8.6). A total of 38 patients (56%) received dabigatran and 30 patients (44%) received warfarin. Patients in both groups had a median CHADS2 and HASBLED score of 2. The median number of days to cardioversion was 34.5 (range=22-148) for dabigatran compared to 66.5 (range=32-183) for warfarin (p<0.01). Total costs of anticoagulation for warfarin averaged $183.50 (SD=95.02) from initiation of anticoagulation to the end of the required four week period following cardioversion, whereas dabigatran costs averaged $193.20 (SD=59.38). Three patients (10%) in the warfarin group had DCCV rescheduled compared to none in the dabigatran group. There was one bleeding event in the warfarin group and no thromboembolic events in either group. CONCLUSION: The use of dabigatran prior to elective DCCV results in a significant decrease in number of days from initiation of anticoagulation to cardioversion as compared to warfarin, with a minor increase in total costs.