Background: There are limited data on factors associated with 30-day readmissions and the frequency of avoidable readmissions among patients with stroke and other cerebrovascular disease. Methods: University HealthSystem Consortium (UHC) database records were used to identify patients discharged with a diagnosis of stroke or other cerebrovascular disease at a university hospital from January 1, 2007 to December 31, 2009 and readmitted within 30 days to the index hospital. Logistic regression models were used to identify patient and clinical characteristics associated with 30-day readmission. Two neurologists performed chart reviews on readmissions to identify avoidable cases. Results: Of 2706 patients discharged during the study period, 174 patients had 178 readmissions (6.4%) within 30 days. The only factor associated with 30-day readmission was the index length of stay >10 days (vs <5 days; odds ratio [OR] 2.3, 95% CI [1.4, 3.7]). Of 174 patients readmitted within 30 days (median time to readmission 10 days), 92 (53%) were considered avoidable readmissions including 38 (41%) readmitted for elective procedures within 30 days of discharge, 27 (29%) readmitted after inadequate outpatient care coordination, 15 (16%) readmitted after incomplete initial evaluations, 8 (9%) readmitted due to delayed palliative care consultation, and 4 (4%) readmitted after being discharged with inadequate discharge instructions. Only 5% of the readmitted patients had outpatient follow-up recommended within 1 week. Conclusions: More than half of the 30-day readmissions were considered avoidable. Coordinated timing of elective procedures and earlier outpatient follow-up may prevent the majority of avoidable readmissions among patients with stroke and other cerebrovascular disease.

The much-anticipated arrival of andexanet alfa, a recombinant factor Xa decoy protein that rapidly reverses the anticoagulant effects of direct oral factor Xa inhibitors (FXai) like apixaban and rivaroxaban,1 has many hospital systems wondering how to manage patients who may benefit from reversal but fall outside clear indications. For example, patients with delayed drug clearance due to renal failure may experience major bleeding or require emergent surgery. A recent perspective article in Blood provides an excellent overview of FXai testing and highlights both the limited availability and clinical need for drug-specific FXai testing in critical situations.2 While development of rapid drug-specific assays is underway, methods to quantitate FXai concentrations quickly, especially given the high cost of antidote, are needed right now. Herein, we provide data suggesting that conventional heparin-calibrated anti-Xa tests, performed using standard coagulometers in many U.S. hospitals, may help guide appropriate and cost-effective use of FXai antidote.