Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 1, pp 16–21 | Cite as

Hospital length of stay in patients initiated on direct oral anticoagulants versus warfarin for venous thromboembolism: a real-world single-center study

  • Hisham Badreldin


This study was conducted to describe the real-world hospital length of stay in patients treated with all of the U.S. Food and Drug Administration approved direct oral anticoagulants (DOACs) versus warfarin for new-onset venous thromboembolism (VTE) at a large, tertiary, academic medical center. A retrospective cohort analysis of all adult patients diagnosed with acute onset VTE was conducted. Of the 441 patients included, 261 (57%) patients received DOACs versus 180 (41%) patients received warfarin. In the DOAC group, a total of 92 (35%) patients received rivaroxaban, followed by 83 (32%) patients received apixaban, 50 (19%) patients received dabigatran, and 36 (14%) patients received edoxaban. Patients initiated on DOACs had a statistically significant shorter hospital length of stay compared to patients initiated on warfarin (median 3 days, [IQR 0–5] vs. 8 days [IQR 5–11], P < 0.05). Despite the shorter hospital length of stay in patients receiving DOACs, the overall reported differences between the DOACs group and the warfarin group in terms of recurrent VTE, major bleeding, intracranial bleeding, and gastrointestinal bleeding at 3 and 6 months were deemed to be statistically insignificant.


Venous thromboembolism Direct oral anticoagulants (DOACs) Warfarin Pulmonary embolism Deep vein thrombosis Hospital length of stay 


Compliance with ethical standards

Conflict of interest

The author has no conflicts of interest to declare.

Research involving human and animal participants

This article does not contain any studies with human participants or animals performed by any of the authors. The study was based on patients receiving treatment. IRB waived the need for informed consent because of all patients data were de-identified.


  1. 1.
    Piazza G et al (2009) Venous thromboembolic events in hospitalised medical patients. Thromb Haemost 102:505–510CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Heit JA (2015) Epidemiology of venous thromboembolism. Nat Rev Cardiol 12:464–474CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Piran S, Schulman S (2016) Management of venous thromboembolism: an update. Thromb J 14:23CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    White RH (2003) The epidemiology of venous thromboembolism. Circulation 107:I4–I8CrossRefGoogle Scholar
  5. 5.
    Goldhaber SZ, Bounameaux H (2012) Pulmonary embolism and deep vein thrombosis. Lancet 379:1835–1846CrossRefPubMedGoogle Scholar
  6. 6.
    Hawkins D (2004) Limitations of traditional anticoagulants. Pharmacotherapy 24:62S–65SGoogle Scholar
  7. 7.
    Bauer KA (2013) Pros and cons of new oral anticoagulants. Hematol Am Soc Hematol Educ Program 2013:464–470Google Scholar
  8. 8.
    Weitz JI, Linkins LA (2007) Beyond heparin and warfarin: the new generation of anticoagulants. Expert Opin Investig Drugs 16:271–282CrossRefPubMedGoogle Scholar
  9. 9.
    Jacobson AK (2008) Warfarin monitoring: point-of-care INR testing limitations and interpretation of the prothrombin time. J Thromb Thrombolysis 25:10–11CrossRefPubMedGoogle Scholar
  10. 10.
    Kearon C et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352CrossRefPubMedGoogle Scholar
  11. 11.
    Schulman S et al (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361:2342–2352CrossRefPubMedGoogle Scholar
  12. 12.
    Bauersachs R et al (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363:2499–2510CrossRefPubMedGoogle Scholar
  13. 13.
    Buller HR et al (2012) Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 366:1287–1297CrossRefPubMedGoogle Scholar
  14. 14.
    Agnelli G et al (2013) Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369:799–808CrossRefPubMedGoogle Scholar
  15. 15.
    Buller HR et al (2013) Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 369:1406–1415CrossRefPubMedGoogle Scholar
  16. 16.
    Badreldin H et al (2017) Evaluation of anticoagulation selection for acute venous thromboembolism. J Thromb Thrombolysis 43:74–78CrossRefPubMedGoogle Scholar
  17. 17.
    Saint CA et al (2017) Comparison of hospital length of stay in patients treated with non-vitamin K oral anticoagulants or parenteral agents plus warfarin for venous thromboembolism. SAGE Open Med 5:2050312117719628CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Basto AN et al. (2017) Initiation of direct oral anticoagulants versus warfarin for venous thromboembolism: impact on time to hospital discharge. J Thromb Thrombolysis 45:51–55Google Scholar
  19. 19.
    Bookhart BK et al (2014) Length of stay and economic consequences with rivaroxaban vs enoxaparin/vitamin K antagonist in patients with DVT and PE: findings from the North American EINSTEIN clinical trial program. J Med Econ 17:691–695CrossRefPubMedGoogle Scholar
  20. 20.
    Roberts KM et al. (2015) Length of stay comparison between rivaroxaban and warfarin in the treatment of pulmonary embolism: results from a real-world observational cohort study. Thrombosis 2015:414523CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pharmacy ServicesBrigham and Women’s HospitalBostonUSA
  2. 2.Department of Pharmacy PracticeKing Saud bin Abdulaziz University for Health SciencesRiyadhKingdom of Saudi Arabia

Personalised recommendations