Rivaroxaban as effective as standard therapy in PE patients
Use of rivaroxaban in patients with pulmonary embolism (PE) results in similar PE-related outcomes as standard of care (SOC), although the anticoagulant is associated with fewer hospital-acquired complications (HACs) and lesser total costs, a study has shown.
The study included 6,746 patients with PE (95 percent male), among whom 208 received rivaroxaban, 4,641 received SOC and 1,897 received other anticoagulants. SOC drugs included low-molecular-weight heparin, unfractionated heparin and warfarin.
Propensity score matching was performed to compare PE-related outcomes (recurrent venous thromboembolism, major bleeding and death), hospital-acquired complications (HACs), healthcare resource utilization and costs among patients receiving rivaroxaban vs SOC. Net clinical benefit was defined as one minus the combined rate of PE-related outcomes and HACs.
After matching, comparisons were made between 203 rivaroxaban and 609 SOC users. During a follow-up of 90 days, the rates of PE-related outcomes were similar between rivaroxaban and SOC users, but the number of patients who had at least one HAC was smaller in the rivaroxaban group (10.3 vs 15.9 percent; p=0.0506), resulting in better net clinical benefit (82.8 vs 71.1 percent; p=0.001).
Compared with SOC users, rivaroxaban users had fewer outpatient visits per patient (17.0 vs 19.9; p=0.0005), a similar rehospitalization rate (0.2 vs 0.3; p=0.084), lesser inpatient costs (US $3,501 vs $6,189; p<0.0001) and lesser total costs ($10,545 vs $14,192; p=0.0002). A similar pattern of results was observed when the sample was limited to patients with low-risk PE.
A common disease, PE has an estimated annual incidence of 70 cases per 100,000 population. PE commonly results in hospitalization, with a high likelihood of recurrence. The condition can also be fatal. Heparin has long been used as the standard therapy in the management of PE patients, being overlapped and followed by vitamin K antagonist. While effective, the regimens are complex, such that they require injections and regular dose adjustments on the basis of laboratory monitoring. These limitations have been addressed with the recent development of oral anticoagulants directed against factor Xa or thrombin. [N Engl J Med 2012;366:1287-1297]
The present data suggest that rivaroxaban provides similar PE-related benefits as standard therapy, but with the additional advantage of reduced HACs and total costs.