Comparison of Lengths of Stay for Inpatients with Immune Thrombocytopenia Treated with Anti-Rh(D), Intravenous Immunoglobulin, and Steroids

Abstract

AbstractAbstract 4646 Rationale:Anti-Rh(D) is an effective treatment for acute immune thrombocytopenia [ITP]. It has a faster onset of action (1 day) vis a vis corticoids (3 days) and intravenous immunoglobulin [IVIG] (4 days). A direct comparison of length of stay for adult inpatients receiving these therapies has hitherto not been performed. We hypothesized that the length of stay would be shortest for patients treated with anti-Rh(D). Methods:A retrospective chart review was conducted to assess length of stay in relation to treatments proffered for ITP. The defining diagnosis of ITP [coded 287.31] was rendered from the computerised record at St. Luke's-Roosevelt Hospital Center and identified 303 patients, of which 147 received treatments for active ITP within a period spanning 01SEP2005 through 29FEB2012. Treatments consisted of prednisone alone, dexamethasone alone, anti-Rh(D) alone, IVIG alone, and combinations of corticoids and the latter two. An average length of stay was tabulated for each treatment regimen. Age and gender were also recorded. Results:A total of 147 hospitalisations for ITP were noted and the analysis of variance statistical calculation applied thus. The median age was 48 years and the male:female ratio was 1.1:1. Eleven groups were delineated and the means for length of hospital stay with confidence intervals derived. The groups were as follows: Prednisone, Dexamethasone, Methylprednisolone, Anti-Rh(D), IVIG, Prednisone and Anti-Rh(D), Dexamethasone and Anti-Rh(D), Prednisone and IVIG, Dexamethasone and IVIG, Methylprednisolone and IVIG, and Anti-Rh(D) and IVIG or Dexamethasone, Anti-Rh(D), and IVIG. The overall p-value for length of stay was 0.0016 (Table 1). The shortest stays were recorded for the corticoid alone groups; however, the mean stay for anti-Rh(D) was shorter than that of IVIG, both in sole and combined modality treatments.Table 1Length of stay for inpatients treated with various regimens for active ITPnMean LOS95% CISDOverall p-valuePrednisone124.080.69 to 7.472.310.0016Dexamethasone183.941.18 to 6.712.04Methylprednisolone315.338.56 to 22.1112.5Anti-Rh(D)364.752.79 to 6.715.50IVIG275.703.45 to 7.964.44Prednisone and Anti-Rh(D)54.40−0.85 to 9.652.07Dexamethasone and Anti-Rh(D)58.202.95 to 13.453.11Prednisone and IVIG117.734.19 to 11.275.88Dexamethasone and IVIG1711.478.62 to 14.3211.50Methylprednisolone and IVIG86.252.10 to 10.405.44Anti-Rh(D) and IVIG or Dexamethasone, Anti-Rh(D), and IVIG59.804.55 to 15.053.35 Conclusion:Anti-Rh(D) is favourable with respect to hospital stay duration. Although corticoids result in still shorter lengths of stay, anti-Rh(D) demonstrated a shorter length of stay compared with IVIG. Combined with its single dosing and relative cost savings, anti-Rh(D) is an excellent alternative to IVIG. Disclosures:No relevant conflicts of interest to declare.