Rivaroxaban program for acute venous thromboembolism upon ED discharge, with focus on utility of commercially available dose pack.
OBJECTIVE
To evaluate the impact of a rivaroxaban discharge initiative on the efficacy and safety of acute venous thromboembolism treatment in emergency department patients.


PRACTICE INNOVATION
Patients discharged on rivaroxaban from the emergency department were provided extensive counseling along with a commercially-available medication dose pack by the ED pharmacist. Patients were contacted by phone until they had obtained outpatient follow-up and remained adherent to anticoagulation beyond the initial first month of treatment.


METHODS
In this retrospective chart review over a thirteen month period, efficacy and safety outcomes were compared between patients with intervention versus those who received usual care. Efficacy was defined by reduced 90-day readmission rates due to nonadherence or treatment failure, and improved medication adherence beyond the first month from discharge. Safety was determined by comparing 90-day readmission rates due to bleeding or adverse event.


RESULTS
41 patients received intervention with rivaroxaban, and 34 patients received usual care, with 76% prescribed rivaroxaban and remaining patients started on enoxaparin alone (6%) or enoxaparin plus warfarin (18%). Improved treatment efficacy in the intervention group was not found to be statistically significant. Safety outcomes were similar between the two groups.


CONCLUSION
Home treatment of acute VTE, facilitated by medication dose pack, is a promising tactic to ensure both immediate and long-term treatment efficacy and safety. Further studies are warranted to demonstrate clinical superiority of this intervention.
['Chu|Aileen|A|', 'Limberg|Jill|J|']
D000284:Administration, Oral D037001:Directive Counseling D065427:Factor Xa Inhibitors D005260:Female D006801:Humans D008297:Male D055118:Medication Adherence D008875:Middle Aged D010351:Patient Discharge D010360:Patient Transfer D012189:Retrospective Studies D000069552:Rivaroxaban D014481:United States D054556:Venous Thromboembolism
Venous thromboembolism Anticoagulation Medication adherence Transitions of care