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Hospitals provide inpatient and outpatient services. Inpatient services provide care to patients that stay in the hospital for an extended period, ranging from days to months. Examples of inpatient services include intensive care units, hospital wards, or surgeries. Outpatient services provide care to patients who come to a hospital for a diagnostic or treatment but do not stay overnight —for example, diagnostic tests, surgical procedures, or health education.
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Hospitals offer medical and surgical care to the sick and injured, along with accommodation while they recover. At the same time, they also provide outpatient, emergency, psychiatric, and rehabilitation services to meet various community needs. In addition to providing medical care, hospitals also act as hubs for medical research and training. Hospitals use clinical procedures and evidence-based practice standards to deliver patient care. To deliver safe and efficient care, a nurse must stay up...
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Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness.

Alex C Spyropoulos1, Walter Ageno1, Gregory W Albers1

  • 1From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institute for Medical Research, and the Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital (A.C.S.), and the Cardiovascular Institute, Mount Sinai Medical Center (J.L.H.) - all in New York; the Department of Medicine and Surgery, University of Insubria, Varese, Italy (W.A.); the Stanford Stroke Center, Stanford University Medical Center, Stanford (G.W.A.), and the University of California at Davis, Sacramento (G.A.M.) - both in California; the Department of Medicine, Intermountain Medical Center, and Department of Medicine, University of Utah, Salt Lake City (C.G.E.); Division of Cardiology, University of Colorado School of Medicine, and CPC Clinical Research, Aurora (W.R.H.); Département Hospitalo-Universitaire FIRE (Fibrose Inflammation Remodelage), University Paris Diderot, Assistance Publique-Hôpitaux de Paris, and INSERM Unité 1148, Paris (P.G.S.); Imperial College, Royal Brompton Hospital, London (P.G.S.); McMaster University and the Thrombosis and Atherosclerosis Research Institute - both in Hamilton, ON, Canada (J.I.W.); Janssen Research and Development, Raritan (E.S., E.S.B.), and the Thrombosis and Hematology Therapeutic Area, Clinical Development, Pharmaceuticals, Bayer U.S., Whippany (T.E.S.) - both in New Jersey; and the College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City (G.E.R.).

The New England Journal of Medicine
|August 28, 2018
PubMed
Summary

Extended thromboprophylaxis with rivaroxaban did not significantly reduce venous thromboembolism risk in medically ill patients post-discharge. Major bleeding events were infrequent in both rivaroxaban and placebo groups.

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Area of Science:

  • Medical research
  • Clinical trials
  • Pharmacology

Background:

  • Hospitalized medical patients face venous thromboembolism (VTE) risk post-discharge.
  • Extended thromboprophylaxis for these patients remains controversial.

Purpose of the Study:

  • To evaluate the efficacy and safety of extended rivaroxaban thromboprophylaxis in high-risk medically ill patients after hospital discharge.

Main Methods:

  • A randomized, double-blind trial involving 12,019 patients at increased VTE risk.
  • Patients received either rivaroxaban (10 mg daily) or placebo for 45 days post-discharge.
  • Outcomes included composite VTE or VTE death (efficacy) and major bleeding (safety).

Main Results:

  • Rivaroxaban showed no significant reduction in the primary efficacy outcome (VTE or VTE death) compared to placebo (0.83% vs. 1.10%).
  • A significant reduction was observed in symptomatic non-fatal VTE for rivaroxaban (0.18% vs. 0.42%).
  • Major bleeding incidence was low and not significantly different between groups (0.28% vs. 0.15%).

Conclusions:

  • Forty-five-day rivaroxaban post-discharge did not significantly lower the risk of VTE or VTE death in medically ill patients.
  • The study suggests limited benefit for extended thromboprophylaxis in this population, with low bleeding risk.