Patient Care Hematology & Oncology - October 2007 - (Page 14)

I Bridge anticoagulation Since there are no randomized controlled trials to assure the safety and efficacy of LMWH in periprocedural bridging, a careful risk-benefit analysis should be undertaken prior to its use. —Mark G. Graham, MD tion should be given at least 2 in away from the navel, rotating the site each time. Plastic bellies are available for teaching patients how to inject. Sharps containers are also provided for discarding syringes. The availability of LMWH at retail pharmacies is limited. The cost of a dose of LMWH can range from $50 to $100, and the retail cost of a week’s supply of LMWH is approximately $1,000. Some insurance companies have medical insurance infusion benefits that will cover the use of LMWH, but most will require prior authorization. For indigent patients, most pharmaceutical companies offer patient assistance programs that will provide medication without charge. There was no difference in thromboembolic complications or bleeding events. A similar study demonstrated that disease management protocols and the use of LMWH (enoxaparin) for bridge therapy resulted in cost savings of approximately $212,475 per year in an HMO without changes in efficacy or safety when compared with the use of UFH.12 It remains to be said that prospective clinical trials are under way comparing UFH and LMWH in periprocedural bridge therapy. These studies should provide stronger evidence for a recommendation. I This article was contributed and updated by Drs Perez and Graham and edited by Peter D’Epiro, PhD. Drs Perez and Graham disclose that they have no financial relationship with any manufacturers in this area of medicine. REFERENCES 1. Ansell J, Hirsh J, Poller L, et al. The pharmacology and management of the vitamin k antagonists: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126:204S-233S. 2. Hirsh J, Fuster V, Ansell J, et al. American Heart Association/American College of Cardiology foundation guide to warfarin therapy. Circulation. 2003;107:1692-1711. 3. Jafri SM, Metha TP. Periprocedural management of anticoagulation in patients on extended warfarin therapy. Semin Thromb Hemost. 2004; 30:657-664. 4. Jafri SM. Periprocedural thromboprophylaxis in patients receiving chronic anticoagulation therapy. Am Heart J. 2004;147:3-15. 5. Dunn AS, Turpie AG. Perioperative management of patients receiving oral anticoagulation: a systematic review. Arch Intern Med. 2003;163: 901-908. 6. Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126:188S-203S. 7. Hassell K. The management of patients with heparin-induced thrombocytopenia who require anticoagulant therapy. Chest. 2005;127(2):1S-8S. 8. Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention. The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126:311S-337S. 9. Kearon C, Hirsh J. Current concepts: management of anticoagulation before and after elective surgery. N Engl J Med. 1997;336:1506-1511. 10. Douketis JD. Perioperative anticoagulation management in patients who are receiving oral anticoagulant therapy: a practical guide for clinicians. Thromb Res. 2002;108:3-13. 11. Spyropoulos AC, Frost FJ, Hurley JS, et al. Costs and clinical outcomes associated with low-molecular-weight heparins vs unfractionated heparin for perioperative bridging in patients receiving long-term oral anticoagulant therapy. Chest. 2004;125:1642-1650. 12. Spyropoulos AC, Jenkins P, Bornikova L. A disease management protocol for outpatient perioperative bridge therapy with enoxaparin in patients requiring temporary interruption of long-term oral anticoagulation. Pharmacotherapy. 2004;24:649-658. Costs associated with bridge therapy In 2004, researchers reported a pharmacoeconomic analysis of costs and clinical outcomes associated with LMWH versus UFH in the perioperative period of patients receiving chronic OAC.11 In the UFH group, patients received bridge therapy in the hospital, while the LMWH group received bridge therapy mostly as outpatients. Bridging with UFH was significantly more expensive than with LMWH: $31,625 versus $18,511 (P .01). Both groups were similar in terms of demographic and clinical characteristics. The difference in costs was attributed to the lower costs of inpatient care with LMWH (about half as much as with UFH), despite higher costs in outpatient care. 14 PATIENT CARE HEMATOLOGY & ONCOLOGY www.patientcareonline.com http://www.patientcareonline.com

Table of Contents Feed for the Digital Edition of Patient Care Hematology & Oncology - October 2007

Patient Care - Hematology & Oncology - October 2007 Research Digest Contents Information for Authors Medicine in the News Strategies for Bridge Anticoagulation Therapy How to Integrate the New Cervical Cancer Guidelines into Practice Dermatology Case Challenge Clinical Clips Classified Advertising

Patient Care Hematology & Oncology - October 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.