Rx for Arrhythmia Shortens Hospital Stay

Dabigatran for atrial fibrillation may cut hospital stay by a day

(RxWiki News) The average price for a day in the hospital can be close to $4,000. So anything that can safely reduce hospital days would be welcome by both patients and insurers.

For patients with atrial fibrillation (AF), it may be as simple as a single medication change to cut out a day in the hospital.

Recent research found that dabigatran, an anticoagulant, shortened hospital stays for AF patients compared to the current standard anticoagulation regimen.

"Find out risks and benefits of new treatment for atrial fibrillation."

David A Vorchheimer, MD, associate professor of medicine, cardiology at Mount Sinai Hospital in New York City, led the study of 36 patients who were hospitalized with newly diagnosed AF.

AF is an irregular and often rapid heart rate that can cause poor blood flow to the body. When a patient has this condition, the upper chambers of the heart (or atria) are not moving blood forcefully through, so the blood can become sluggish and form clots.

Dabigatran (brand name Pradaxa) is an anticoagulant, or medication that prevents coagulation (clotting) of blood. It helps prevent stroke in patients with AF.

Half the patients in this research received anti-clotting dabigatran while the other 18 received standard anticoagulation treatment.

The standard treatment involved taking the long-established anticoagulant warfarin (brand name Coumadin). Warfarin can take up to five days to start working. Some patients also took enoxaparin (brand name Lovenox) or unfractionated heparin with warfarin. These start treating clotting before the warfarin kicks in.  

The length of the hospital stay during the warfarin anticoagulation regimen was three days on average for the dabigatran patients vs. four days on average for the warfarin subjects.

Dr. Vorchheimer told dailyRx News, “For patients receiving dabigatran instead of warfarin, the average patient had two days less of anticoagulation in the hospital, and that translated into one day out of the hospital sooner.”

Note that dabigatran costs more than warfarin. Dabigatran’s wholesale cost is about $200 per month compared to $30 to $50 for warfarin, according to a study published in March 2012 in the journal Stroke. Lead author Hooman Kamel, MD, assistant professor, neurology, at Weill Cornell Medical College in New York, pointed out that in the long run dabigatran is still cost effective.

While there have been reports recently of dabigatran causing excessive bleeding, Dr. Vorchheimer did not observe any in his study. 

“There is a very clear list for patients who should be getting this kind of drug and who should not be getting this kind of drug,” he said.

Dr. Vorchheimer added the cost of treatment is becoming an increasingly important component of effective health care.

He told dailyRx News, “If the finding observed in our relatively small study showing shorter hospital stay with dabigatran is indeed confirmed by larger trials in the future this finding could be one additional factor in the selection of anticoagulant therapy for patients."

The study was presented in March at the American College of Cardiology 2013 Scientific Session. Vorchheimer and his colleagues report that they have no relevant relationships to disclose; the analysis received no industry support.

Review Date: 
March 20, 2013