Abstract
Purpose: Warfarin needs several days to reach the steady anticoagulative state, however novel oral anticoagulants (NOACs) does not. It may cause differences in acute hospital stay for stroke and hospital charges between NVAF patients taking warfarin and those taking NOACs. We aimed to determine the association of OAC choice after stroke with length of hospital stay and hospital charges from a multicenter prospective registry (the SAMURAI-NVAF, NCT01581502) involving 18 hospitals. Methods: 634 acute ischemic stroke/TIA survivors with NVAF (277 women, 77±10 years old) who was taking OACs at discharge between Sep 2011 and Jun 2013 were studied; three NOACs were approved for clinical use in NVAF patients in Japan just before or during the periods (dabigatran in Jan 2011, rivaroxaban in Jan 2012, apixaban in Dec 2012). Hospital charges were analyzed using 217 patients in the first author’s hospital where the Diagnosis Procedure Combination, a Japanese diagnosis-dominant case-mix system was used for charges. Results: Warfarin was chosen for 420 patients (66%), dabigatran for 143 (23%), and rivaroxaban for 71 (11%) at hospital discharge. Warfarin users were older (warfarin 79±10, dabigatran 73±9, rivaroxaban 74±10 years old, p<0.001) and more female (47%, 34%, 41%, p=0.021), and had higher scores of admission NIHSS (median 10, 3, 6, p<0.001) and discharge mRS (3.5, 1, 2, p<0.001) than the others. Median hospital stay was longer in warfarin users (28 [IQR 18-36] days) than dabigatran users (15 [12-22] days) and rivaroxaban users (18 [13-26] days, p<0.001). As compared to NOAC use, warfarin use was independently associated with longer stay both after adjustment for sex, age, and initial NIHSS score (p<0.001) and after adjustment for sex, age, and discharge mRS (p<0.001). Median hospital charges were 1,623*10 3 [IQR 980-2141] JPY for warfarin users (n=137), 967*10 3 [IQR 716-1240] JPY for dabigatran users (n=43), and 1,354*10 3 [IQR 944-2063] JPY for rivaroxaban users (n=137, p<0.001). There was no independent association of OAC choice with hospital charges after multivariate adjustment. Conclusion: Use of NOACs for secondary prevention shortened acute hospital stay after stroke/TIA independently from stroke severity.
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