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Anticoagulant use, the prevalence of bridging, and relation to length of stay among hospitalized patients with non-valvular atrial fibrillation.

Smoyer-Tomic K, Siu K, Walker DR, Johnson BH, Smith DM, Sander S, Amin A - Am J Cardiovasc Drugs (2012)

Bottom Line: LOS was reported for non-bridged patients (warfarin only) and compared with three bridging regimens: low molecular weight heparin/pentasaccharide (LMWH/PS); unfractionated heparin (UFH); and two-agent bridging (LMWH/PS and UFH).Following multivariate analysis, relative to patients who received inpatient warfarin only, LOS was significantly higher for patients with UFH (19.3%) and patients with two-agent bridging (45.1%).Patients with pre-period warfarin, cancer, or diabetes mellitus who received bridging agents had significantly longer LOS than patients with those conditions who were not bridged.

View Article: PubMed Central - PubMed

Affiliation: Truven Health Analytics Inc., Washington, DC 20008, USA.

ABSTRACT

Objective: The objectives of this study were to describe inpatient anticoagulation and bridging in patients with non-valvular atrial fibrillation (NVAF) and to identify whether differences exist in length of stay (LOS) among bridged versus non-bridged NVAF patients.

Design: Administrative claims data were used to select patients ≥18 years with a primary or secondary discharge diagnosis of NVAF and inpatient warfarin use from 1 July 2004 to 30 September 2009. Patients with valvular or transient causes of NVAF or pregnancy were excluded. Inpatient bridging was defined as receipt of an anticoagulant in addition to warfarin during the hospitalization. LOS was reported for non-bridged patients (warfarin only) and compared with three bridging regimens: low molecular weight heparin/pentasaccharide (LMWH/PS); unfractionated heparin (UFH); and two-agent bridging (LMWH/PS and UFH). Multivariate analyses were performed to evaluate the association between bridging and LOS, adjusting for demographic and clinical variables.

Results: Of 6340 NVAF patients, 48% received inpatient warfarin (mean LOS 5.5 days); among them, 64% received bridging therapy (mean LOS 6.3 days) [LMWH/PS 45% (mean LOS 5.6 days), UFH 36% (mean LOS 6.0 days), two-agent bridging 18% (mean LOS 8.4 days)]. Following multivariate analysis, relative to patients who received inpatient warfarin only, LOS was significantly higher for patients with UFH (19.3%) and patients with two-agent bridging (45.1%). Patients with pre-period warfarin, cancer, or diabetes mellitus who received bridging agents had significantly longer LOS than patients with those conditions who were not bridged.

Conclusion: LOS was longer for bridged than non-bridged patients. Further studies are needed to identify predictors of bridging and to explain why bridged NVAF patients had longer LOS.

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Related in: MedlinePlus

Estimated LOS during Index hospitalization by bridging regimen and selected variables. The reference LOS is 3.74 days for male aged 73 years, not from the Western region, with total 6-month pre-period costs of $US8800 and all other variables equal to ‘No’. Calculation of LOS reported for interaction terms (e.g. bridge × cancer: LMWH/PS) includes main effects and interaction effects. LOS = length of stay; LMWH/PS = low molecular weight heparin/pentasaccharide; NVAF = non-valvular atrial fibrillation; UFH = unfractionated heparin. * p < 0.05; ** p < 0.01; *** p < 0.001 vs reference.
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Fig3: Estimated LOS during Index hospitalization by bridging regimen and selected variables. The reference LOS is 3.74 days for male aged 73 years, not from the Western region, with total 6-month pre-period costs of $US8800 and all other variables equal to ‘No’. Calculation of LOS reported for interaction terms (e.g. bridge × cancer: LMWH/PS) includes main effects and interaction effects. LOS = length of stay; LMWH/PS = low molecular weight heparin/pentasaccharide; NVAF = non-valvular atrial fibrillation; UFH = unfractionated heparin. * p < 0.05; ** p < 0.01; *** p < 0.001 vs reference.

Mentions: There were no significant changes in predicted LOS from the reference population for individual variables of pre-period warfarin use or occurrence of cancer or diabetes. Thus among NVAF patients not receiving bridging therapy, there was no difference in LOS for those with cancer versus those without cancer. However, significant increases in predicted LOS were observed for NVAF patients with cancer who received bridging therapy compared with the reference NVAF group without cancer and without bridging therapy. Similarly, among non-bridged groups, the models did not predict differences in LOS for NVAF patients with pre-period warfarin use or diabetes as compared with the reference NVAF group. As with cancer, estimated LOS was higher for patients with pre-period warfarin use or with diabetes in conjunction with inpatient bridging therapy. The greatest increase in LOS (101.2%, p = 0.0107) was found for patients with cancer who received two-agent (LMWH/PS and UFH) bridging with inpatient warfarin. Predicted LOS for these patients was 7.53 days, compared with the reference LOS of 3.74 days (no cancer and no bridging therapy) and the predicted LOS for cancer and no bridging therapy of 4.05 days (figure 3). Similarly, patients with diabetes who also received bridging had a 24.5% increase in LOS with LMWH/PS, 21.1% higher with UFH, and 54.4% higher with both bridging agents than the reference LOS of 3.74 days for a non-diabetic AF patient receiving inpatient warfarin (table IV). For the three clinical variables shown here, no differences were predicted in LOS as compared with the reference group, but the addition of bridging therapy resulted in longer predicted LOS for each variable.


Anticoagulant use, the prevalence of bridging, and relation to length of stay among hospitalized patients with non-valvular atrial fibrillation.

Smoyer-Tomic K, Siu K, Walker DR, Johnson BH, Smith DM, Sander S, Amin A - Am J Cardiovasc Drugs (2012)

Estimated LOS during Index hospitalization by bridging regimen and selected variables. The reference LOS is 3.74 days for male aged 73 years, not from the Western region, with total 6-month pre-period costs of $US8800 and all other variables equal to ‘No’. Calculation of LOS reported for interaction terms (e.g. bridge × cancer: LMWH/PS) includes main effects and interaction effects. LOS = length of stay; LMWH/PS = low molecular weight heparin/pentasaccharide; NVAF = non-valvular atrial fibrillation; UFH = unfractionated heparin. * p < 0.05; ** p < 0.01; *** p < 0.001 vs reference.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3713944&req=5

Fig3: Estimated LOS during Index hospitalization by bridging regimen and selected variables. The reference LOS is 3.74 days for male aged 73 years, not from the Western region, with total 6-month pre-period costs of $US8800 and all other variables equal to ‘No’. Calculation of LOS reported for interaction terms (e.g. bridge × cancer: LMWH/PS) includes main effects and interaction effects. LOS = length of stay; LMWH/PS = low molecular weight heparin/pentasaccharide; NVAF = non-valvular atrial fibrillation; UFH = unfractionated heparin. * p < 0.05; ** p < 0.01; *** p < 0.001 vs reference.
Mentions: There were no significant changes in predicted LOS from the reference population for individual variables of pre-period warfarin use or occurrence of cancer or diabetes. Thus among NVAF patients not receiving bridging therapy, there was no difference in LOS for those with cancer versus those without cancer. However, significant increases in predicted LOS were observed for NVAF patients with cancer who received bridging therapy compared with the reference NVAF group without cancer and without bridging therapy. Similarly, among non-bridged groups, the models did not predict differences in LOS for NVAF patients with pre-period warfarin use or diabetes as compared with the reference NVAF group. As with cancer, estimated LOS was higher for patients with pre-period warfarin use or with diabetes in conjunction with inpatient bridging therapy. The greatest increase in LOS (101.2%, p = 0.0107) was found for patients with cancer who received two-agent (LMWH/PS and UFH) bridging with inpatient warfarin. Predicted LOS for these patients was 7.53 days, compared with the reference LOS of 3.74 days (no cancer and no bridging therapy) and the predicted LOS for cancer and no bridging therapy of 4.05 days (figure 3). Similarly, patients with diabetes who also received bridging had a 24.5% increase in LOS with LMWH/PS, 21.1% higher with UFH, and 54.4% higher with both bridging agents than the reference LOS of 3.74 days for a non-diabetic AF patient receiving inpatient warfarin (table IV). For the three clinical variables shown here, no differences were predicted in LOS as compared with the reference group, but the addition of bridging therapy resulted in longer predicted LOS for each variable.

Bottom Line: LOS was reported for non-bridged patients (warfarin only) and compared with three bridging regimens: low molecular weight heparin/pentasaccharide (LMWH/PS); unfractionated heparin (UFH); and two-agent bridging (LMWH/PS and UFH).Following multivariate analysis, relative to patients who received inpatient warfarin only, LOS was significantly higher for patients with UFH (19.3%) and patients with two-agent bridging (45.1%).Patients with pre-period warfarin, cancer, or diabetes mellitus who received bridging agents had significantly longer LOS than patients with those conditions who were not bridged.

View Article: PubMed Central - PubMed

Affiliation: Truven Health Analytics Inc., Washington, DC 20008, USA.

ABSTRACT

Objective: The objectives of this study were to describe inpatient anticoagulation and bridging in patients with non-valvular atrial fibrillation (NVAF) and to identify whether differences exist in length of stay (LOS) among bridged versus non-bridged NVAF patients.

Design: Administrative claims data were used to select patients ≥18 years with a primary or secondary discharge diagnosis of NVAF and inpatient warfarin use from 1 July 2004 to 30 September 2009. Patients with valvular or transient causes of NVAF or pregnancy were excluded. Inpatient bridging was defined as receipt of an anticoagulant in addition to warfarin during the hospitalization. LOS was reported for non-bridged patients (warfarin only) and compared with three bridging regimens: low molecular weight heparin/pentasaccharide (LMWH/PS); unfractionated heparin (UFH); and two-agent bridging (LMWH/PS and UFH). Multivariate analyses were performed to evaluate the association between bridging and LOS, adjusting for demographic and clinical variables.

Results: Of 6340 NVAF patients, 48% received inpatient warfarin (mean LOS 5.5 days); among them, 64% received bridging therapy (mean LOS 6.3 days) [LMWH/PS 45% (mean LOS 5.6 days), UFH 36% (mean LOS 6.0 days), two-agent bridging 18% (mean LOS 8.4 days)]. Following multivariate analysis, relative to patients who received inpatient warfarin only, LOS was significantly higher for patients with UFH (19.3%) and patients with two-agent bridging (45.1%). Patients with pre-period warfarin, cancer, or diabetes mellitus who received bridging agents had significantly longer LOS than patients with those conditions who were not bridged.

Conclusion: LOS was longer for bridged than non-bridged patients. Further studies are needed to identify predictors of bridging and to explain why bridged NVAF patients had longer LOS.

Show MeSH
Related in: MedlinePlus