Reducing length of stay with the direct oral anti-coagulants in low and intermediate risk pulmonary embolism: a single center experience

Jason Filopei, Eric E. Bondarsky, Madeline Ehrlich, Marjan Islam, Gargi Bajpayee, Daniel Pang, Adil Shujaat, John Rowland, David J. Steiger

Research output: Contribution to journalArticlepeer-review


Direct oral anti-coagulants (DOACs) reduce hospital length-of-stay (LOS) in patients with acute pulmonary embolism (PE) in clinical trials. There is a paucity of literature describing real world utility of DOACs, particularly in intermediate-risk patients. To evaluate if the utilization of DOACs vs. non-DOACs in acute PE patients, reduces LOS without a difference in safety in patients defined as low and intermediate-risk of mortality by the European Society of Cardiology. This was a retrospective cohort study of prospectively collected data from a single center registry of consecutive adult outpatients diagnosed with acute PE who survived to hospital discharge. Primary outcome was median hospital LOS. Secondary outcomes were 30-day readmission, survival, and incidence of major and minor bleeding. There were 307 outpatients admitted with acute PE 88 (28.7%) low-risk, 213 (69.4%) intermediate-risk, and 6 (2.0%) high-risk. Two hundred and twenty-six (73.6%) received a DOAC. There was a statistically significant shorter median LOS in all patients treated with a DOAC (2.9 days, IQR 1.8–4.7) vs non-DOAC (4.9 days, IQR 3–8.9) (Generalized Linear Model p < 0.001). There was a shorter median LOS between intermediate-risk patients treated with a DOAC (3.6 days, IQR 2–5.8) vs non-DOAC (5, IQR 3–9). There was no difference in 30-day readmission, survival, or bleeding complications in both cohorts. There was a reduction in LOS in low and intermediate risk patients treated with a DOAC without a difference in 30-day safety and efficacy. Treating acute PE patients with DOACs including intermediate-risk patients, compared to conventional anticoagulation, may facilitate early discharge, and potentially reduce hospital costs.

Original languageEnglish
Pages (from-to)399-407
Number of pages9
JournalJournal of Thrombosis and Thrombolysis
Issue number2
StatePublished - 1 Aug 2020


  • Anticoagulation therapy
  • Diagnosis
  • Hematology–hemostasis & thrombosis
  • Oral anticoagulants
  • Thrombosis
  • Treatment
  • Venous thromboembolism prophylaxis


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