Jessica Franchino-elder: No disclosure data submitted.
Michaela Petrini: No disclosure data submitted.
Cheng Wang: No disclosure data submitted.
Scott Robinson: No disclosure data submitted.
Zhun Cao: No disclosure data submitted.
Background and Objectives: Reverse anticoagulant agents such as prothrombin complex concentrates (PCC) and idarucizumab (IDA) may be used for urgent reversal of acquired coagulation factor deficiency induced by warfarin, or specific reversal of dabigatran, respectively. There is a dearth of publications regarding resources used in hospitals or whether resource consumption varies by type of reversal agent. We examined hospital resources used (HRU) among patients with Non-Valvular Atrial Fibrillation (NVAF) encountering life-threatening bleeds or emergency surgery in a U.S. hospital setting.
Methods: A retrospective observational study was performed using the Premier Healthcare Database. Eligible patients included those aged ≥18 years who received IDA for reversal of dabigatran, or 3- or 4-factor PCC for reversal of warfarin, during an inpatient hospitalization between October 2015 and February 2018. Descriptive analyses of HRU by type and reason for reversal, including life-threatening bleeds and emergency surgery/urgent procedures was conducted.
Results: Median age was 78 [IQR: 70-85] years in IDA and 74 (IQR: 65-83, n=1,232) years in PCC (n=4,939) patients. In IDA patients, median LOS was 5 days (IQR:3-9; n=626) and transfusion rate was 22.0% in those with life-threatening bleeds; median LOS was 6 days (IQR: 3-10, n=270) and transfusion rate was 20.4% in those with emergency surgery/urgent procedures. In PCC patients, median LOS was 5 days (IQR:3-9; n=2,212) and 28.1% had a transfusion for a life-threatening bleed; median LOS was 10 days (IQR: 6-18; n=932) and the transfusion rate was 48.5% for emergency surgery/urgent procedures. When stratified by type of bleed, IDA patients with a gastrointestinal (GI) bleed had a median LOS of 5 days (IQR: 3-9; n=451) and transfusion rate of 33.0%, while IDA patients with Intracranial hemorrhage (ICH) had a median LOS of 4 days (IQR: 2-8; n=243) and transfusion rate of 7.4%. PCC patients with a GI bleed had a median LOS of 6 days (IQR: 4-11, n=1,380) and transfusion rate of 37.4%. PCC patients with ICH had a median LOS of 6 days (IQR:3-11; n=1,211) and transfusion rate of 28.2%.
Conclusion: In this descriptive analysis, HRU appeared to be lower in patients who received IDA than among those administered a PCC. This observation was consistent among patients subset by cause of reversal and bleeding type.