A disease management protocol for outpatient perioperative bridge therapy with enoxaparin in patients requiring temporary interruption of long-term oral anticoagulation.
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.


METHODS
Retrospective review of all clinic notes from an anticoagulation clinic.


METHODS
An integrated, staff-model health maintenance organization.


METHODS
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


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 dollars 903,020. No thrombotic events were reported. Three major hemorrhagic events that required discontinuation of LMWH were reported.


CONCLUSIONS
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 dollars 212,475/year in an integrated health maintenance organization. In addition, this strategy appears both safe and effective.
Spyropoulos
Alex C
AC
Clinical Thrombosis Center, Lovelace Sandia Health Systems, Albuquerque, New Mexico 87108, USA. alex.spyropoulos@lovelacesandia.com
Jenkins
Patti
P
Bornikova
Larissa
L
D000284:Administration, Oral; D000553:Ambulatory Care / Q000191:economics / Q000379:methods*; D000925:Anticoagulants / Q000008:administration & dosage*; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors
D000925:Anticoagulants; D017984:Enoxaparin