A Disease Management Protocol for Outpatient Perioperative Bridge Therapy with Enoxaparin in Patients Requiring Temporary Interruption of Long‐Term Oral Anticoagulation
- 1 May 2004
- journal article
- website
- Published by Wiley in Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
- Vol. 24 (5) , 649-658
- https://doi.org/10.1592/phco.24.6.649.34740
Abstract
Study Objective. Traditional perioperative bridge therapy for patients receiving long‐term oral anticoagulation involves weight‐adjusted intravenous unfractionated heparin (UFH) in the perioperative period during temporary discontinuation of the oral anticoagulant. We sought to determine whether an alternate strategy of outpatient‐based perioperative disease management with low‐molecular‐weight heparin (LMWH) as bridge therapy provides the potential for cost savings.Design. Retrospective review of all clinic notes from an anticoagulation clinic.Setting. An integrated, staff‐model health maintenance organization.Patients. Patients receiving long‐term warfarin therapy from January 1998–March 2002 who received perioperative bridge therapy with the LMWH enoxaparin 1 mg/kg twice/day subcutaneously.Measurements and Main Results. A total of 126 bridge therapy encounters in 84 patients receiving LMWH as perioperative bridge therapy were identified, with 48 of those encounters involving patients with at least one mechanical heart valve. A total of 1108 hospital bed days were saved. Based on 1996 cost estimates, the total approximate cost savings for the 4.25 years of the outpatient bridge therapy program was $903,020. No thrombotic events were reported. Three major hemorrhagic events that required discontinuation of LMWH were reported.Conclusion. Outpatient‐based disease management protocols and the LMWH enoxaparin as bridge therapy during temporary discontinuation of warfarin for an elective surgical procedure resulted in cost savings of approximately $212,475/year in an integrated health maintenance organization. In addition, this strategy appears both safe and effective.Keywords
This publication has 11 references indexed in Scilit:
- Interventions used in disease management programmes for patients with chronic illness---which ones work? Meta-analysis of published reportsBMJ, 2002
- Dalteparin as Periprocedure Anticoagulation for Patients on Warfarin and at High Risk of ThrombosisAnnals of Pharmacotherapy, 2001
- Managing Oral Anticoagulant TherapyChest, 2001
- Low Molecular Weight Heparin After Mechanical Heart Valve ReplacementCirculation, 2000
- Successful Anticoagulation with Dalteparin in a Patient with Mechanical Heart ValvesAnnals of Pharmacotherapy, 1999
- Use of enoxaparin for the chronically anticoagulated patient before and after proceduresThe American Journal of Cardiology, 1999
- Acute Myocardial Infarction: Selection of Reperfusion Strategies in the Individual PatientThrombosis and Haemostasis, 1999
- Guidelines for the Management of Patients With Valvular Heart DiseaseCirculation, 1998
- Low-Molecular-Weight HeparinsNew England Journal of Medicine, 1997
- Management of Anticoagulation before and after Elective SurgeryNew England Journal of Medicine, 1997