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

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, facilitate early discharge, and potentially reduce hospital costs.