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Immediate Discharge and Home Treatment With Rivaroxaban of Low‐risk Venous Thromboembolism Diagnosed in Two U.S. Emergency Departments: A One‐year Preplanned Analysis
Author(s) -
Beam Daren M.,
Kahler Zachary P.,
Kline Jeffrey A.
Publication year - 2015
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12711
Subject(s) - medicine , rivaroxaban , pulmonary embolism , deep vein , emergency department , confidence interval , venous thrombosis , thrombosis , venous thromboembolism , surgery , warfarin , atrial fibrillation , psychiatry
Objectives The study hypothesis was that a target‐specific anticoagulant would allow successful home treatment of selected patients with deep vein thrombosis ( DVT ) and pulmonary embolism ( PE ) diagnosed in two urban emergency departments ( ED s). Methods A protocol was established for treating low‐risk DVT or PE patients with rivaroxaban and clinic, follow‐up at both 2 to 5 weeks, and 3 to 6 months. Patients were determined to be low‐risk by using a modified version of the Hestia criteria, supplemented by additional criteria for patients with active cancer. Acceptable outcome rates were defined as venous thromboembolism ( VTE ) recurrence ≤ 2.1% or bleeding ≤ 9.4% during treatment. VTE recurrence required positive imaging of any VTE . The International Society of Thrombosis and Hemostasis definition of major or clinically relevant nonmajor bleeding was used. Results From March 2013 through April 2014, a total of 106 patients were treated. Seventy‐one (68%) had DVT , 30 (28%) had PE , and five (3%) had both, representing 51% of all DVT s and 27% of all PE s diagnosed in both ED s during the period of study. The 106 patients have been followed for a mean (± SD ) of 389 (±111) days (range = 213 to 594 days). No patient had VTE recurrence, and no patient had a major or clinically relevant bleeding event while on therapy (none of the 106, 0%, 95% confidence interval [ CI ] = 0% to 3.4%). However, three patients 2.8% (95% CI = 1% to 8%) had recurrent DVT after cessation of therapy. Conclusions Patients diagnosed with VTE and immediately discharged from the ED while treated with rivaroxaban had a low rate of VTE recurrence and bleeding.