Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trialCentral MessagePerspective
Objectives: Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperat...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-09-01
|
| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623001201 |
| _version_ | 1797674107525922816 |
|---|---|
| author | Marcel de Paula Pereira, MD Eduardo Gomes Lima, MD, PhD Fabio Grunspun Pitta, MD Luís Henrique Wolff Gowdak, MD, PhD Bruno Mahler Mioto, MD, PhD Leticia Neves Solon Carvalho, MD Francisco Carlos da Costa Darrieux, MD, PhD Omar Asdrubal Vilca Mejia, MD, PhD Fabio Biscegli Jatene, MD, PhD Carlos Vicente Serrano, Jr, MD, PhD |
| author_facet | Marcel de Paula Pereira, MD Eduardo Gomes Lima, MD, PhD Fabio Grunspun Pitta, MD Luís Henrique Wolff Gowdak, MD, PhD Bruno Mahler Mioto, MD, PhD Leticia Neves Solon Carvalho, MD Francisco Carlos da Costa Darrieux, MD, PhD Omar Asdrubal Vilca Mejia, MD, PhD Fabio Biscegli Jatene, MD, PhD Carlos Vicente Serrano, Jr, MD, PhD |
| author_sort | Marcel de Paula Pereira, MD |
| collection | DOAJ |
| description | Objectives: Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperative atrial fibrillation. Methods: A single-center, randomized, prospective, and open-label study. The trial was conducted in Heart Institute at University of São Paulo, Brazil. Patients who developed postoperative atrial fibrillation were randomized to anticoagulation with rivaroxaban or warfarin plus enoxaparin bridging. The primary objective was the cost-effectiveness evaluated by quality-adjusted life years, using the SF-6D questionnaire. The secondary end point was the combination of death, stroke, myocardial infarction, thromboembolic events, infections, bleeding, readmissions, and surgical reinterventions. The safety end point was any bleeding using the International Society on Thrombosis and Haemostasis score. Follow-up period was 30 days after hospital discharge. Results: We analyzed 324 patients and 53 patients were randomized. The median cost-effectiveness was $1423.20 in the warfarin group versus $586.80 in the rivaroxaban group (P = .002). The median cost was lower in the rivaroxaban group, $450.20 versus $947.30 (P < .001). The secondary outcome was similar in both groups, 44.4% in warfarin group versus 38.5% in the rivaroxaban group (P = .65). Bleeding occured in 25.9% in the warfarin group versus 11.5% in the rivaroxaban group (P = .18). Conclusions: Rivaroxaban was more cost-effective when compared with warfarin associated with enoxaparin bridging in postoperative atrial fibrillation after isolated coronary artery bypass grafting. |
| first_indexed | 2024-03-11T21:54:21Z |
| format | Article |
| id | doaj.art-08a4ce2e63dc46769c4a4c0838364193 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-11T21:54:21Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-08a4ce2e63dc46769c4a4c08383641932023-09-26T04:12:29ZengElsevierJTCVS Open2666-27362023-09-0115199210Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trialCentral MessagePerspectiveMarcel de Paula Pereira, MD0Eduardo Gomes Lima, MD, PhD1Fabio Grunspun Pitta, MD2Luís Henrique Wolff Gowdak, MD, PhD3Bruno Mahler Mioto, MD, PhD4Leticia Neves Solon Carvalho, MD5Francisco Carlos da Costa Darrieux, MD, PhD6Omar Asdrubal Vilca Mejia, MD, PhD7Fabio Biscegli Jatene, MD, PhD8Carlos Vicente Serrano, Jr, MD, PhD9Address for reprints: Marcel de Paula Pereira, MD, Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brasil; Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilInstituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilInstituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilInstituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilInstituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilInstituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilInstituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilInstituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilInstituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilInstituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrasilObjectives: Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperative atrial fibrillation. Methods: A single-center, randomized, prospective, and open-label study. The trial was conducted in Heart Institute at University of São Paulo, Brazil. Patients who developed postoperative atrial fibrillation were randomized to anticoagulation with rivaroxaban or warfarin plus enoxaparin bridging. The primary objective was the cost-effectiveness evaluated by quality-adjusted life years, using the SF-6D questionnaire. The secondary end point was the combination of death, stroke, myocardial infarction, thromboembolic events, infections, bleeding, readmissions, and surgical reinterventions. The safety end point was any bleeding using the International Society on Thrombosis and Haemostasis score. Follow-up period was 30 days after hospital discharge. Results: We analyzed 324 patients and 53 patients were randomized. The median cost-effectiveness was $1423.20 in the warfarin group versus $586.80 in the rivaroxaban group (P = .002). The median cost was lower in the rivaroxaban group, $450.20 versus $947.30 (P < .001). The secondary outcome was similar in both groups, 44.4% in warfarin group versus 38.5% in the rivaroxaban group (P = .65). Bleeding occured in 25.9% in the warfarin group versus 11.5% in the rivaroxaban group (P = .18). Conclusions: Rivaroxaban was more cost-effective when compared with warfarin associated with enoxaparin bridging in postoperative atrial fibrillation after isolated coronary artery bypass grafting.http://www.sciencedirect.com/science/article/pii/S2666273623001201postoperative atrial fibrillationanticoagulationdirect oral anticoagulantcoronary artery bypass surgerycost-effectivecosts |
| spellingShingle | Marcel de Paula Pereira, MD Eduardo Gomes Lima, MD, PhD Fabio Grunspun Pitta, MD Luís Henrique Wolff Gowdak, MD, PhD Bruno Mahler Mioto, MD, PhD Leticia Neves Solon Carvalho, MD Francisco Carlos da Costa Darrieux, MD, PhD Omar Asdrubal Vilca Mejia, MD, PhD Fabio Biscegli Jatene, MD, PhD Carlos Vicente Serrano, Jr, MD, PhD Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trialCentral MessagePerspective JTCVS Open postoperative atrial fibrillation anticoagulation direct oral anticoagulant coronary artery bypass surgery cost-effective costs |
| title | Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trialCentral MessagePerspective |
| title_full | Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trialCentral MessagePerspective |
| title_fullStr | Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trialCentral MessagePerspective |
| title_full_unstemmed | Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trialCentral MessagePerspective |
| title_short | Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trialCentral MessagePerspective |
| title_sort | rivaroxaban versus warfarin in postoperative atrial fibrillation cost effectiveness analysis in a single center randomized and prospective trialcentral messageperspective |
| topic | postoperative atrial fibrillation anticoagulation direct oral anticoagulant coronary artery bypass surgery cost-effective costs |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623001201 |
| work_keys_str_mv | AT marceldepaulapereiramd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective AT eduardogomeslimamdphd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective AT fabiogrunspunpittamd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective AT luishenriquewolffgowdakmdphd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective AT brunomahlermiotomdphd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective AT leticianevessoloncarvalhomd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective AT franciscocarlosdacostadarrieuxmdphd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective AT omarasdrubalvilcamejiamdphd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective AT fabiobisceglijatenemdphd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective AT carlosvicenteserranojrmdphd rivaroxabanversuswarfarininpostoperativeatrialfibrillationcosteffectivenessanalysisinasinglecenterrandomizedandprospectivetrialcentralmessageperspective |