Poster 382: Cost Effective Alternative to Warfarin in Deep Vein Thrombosis Prophylaxis in Post Joint Replacement Surgery: A Quality Improvement Project

To assess whether using apixaban for deep vein thrombosis (DVT) prophylaxis would decrease the incidence of subtherapeutic anticoagulation on discharge and lead to at least 20% cost reduction comparing to prophylaxis with enoxaparin bridging to warfarin post total knee arthroplasty (TKA) or total hip arthroplasty (THA). Design: Quality Improvement Study. Setting: Inpatient rehabilitation unit in an academic center. Participants: 10 total knee arthroplasty patients and 5 total hip arthroplasty patients. Interventions: Articles on the current anticoagulation were compiled and presented to the orthopedic nurse practitioners who then relayed the information to the orthopedic surgeons. Two main surgeons agreed to have patients on apixaban 2.5 mg twice daily for 12 days post TKA and 35 days post THA. Data were collected on the incidence of DVT, pulmonary embolism (PE) and bleeding complications on apixaban for the month of June 2018. Main Outcome Measures: We calculated the percentage of patients who were discharged from inpatient rehabilitation with subtherapeu-tic warfarin in January of 2018. The costs of anticoagulation on warfarin which included enoxaparin, warfarin, blood testings, and outpatient anticoagulation visits were compared with the costs of using apixaban alone in the month of June. Results: 60% of patients had subtherapeutic INR on discharge. The average cost per patient was $103.87 for DVT prophylaxis on enox-aparin and warfarin. The average cost on apixaban was $57.25. This is a difference of $46.62 which translates to a 45% in cost reduction. There were no DVT, increased wound drainage, PE or other bleeding complications in the apixaban group. Conclusions: The implementation of apixaban for DVT prophylaxis eliminates the need to test for therapeutic level and leads to a 45% in cost savings. Some of the other added benefits including less need for frequent blood testing and follow-up thus increasing patient's comfort.