PMID- 15162899
OWN - NLM
STAT- MEDLINE
DCOM- 20040817
LR  - 20190917
IS  - 0277-0008 (Print)
IS  - 0277-0008 (Linking)
VI  - 24
IP  - 5
DP  - 2004 May
TI  - A disease management protocol for outpatient perioperative bridge therapy with 
      enoxaparin in patients requiring temporary interruption of long-term oral 
      anticoagulation.
PG  - 649-58
AB  - 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 
      dollars 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 dollars 212,475/year in an 
      integrated health maintenance organization. In addition, this strategy appears 
      both safe and effective.
FAU - Spyropoulos, Alex C
AU  - Spyropoulos AC
AD  - Clinical Thrombosis Center, Lovelace Sandia Health Systems, Albuquerque, New 
      Mexico 87108, USA. alex.spyropoulos@lovelacesandia.com
FAU - Jenkins, Patti
AU  - Jenkins P
FAU - Bornikova, Larissa
AU  - Bornikova L
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Administration, Oral
MH  - Ambulatory Care/economics/*methods
MH  - Anticoagulants/*administration & dosage
MH  - Enoxaparin/*administration & dosage
MH  - Female
MH  - Heart Diseases/surgery
MH  - Humans
MH  - International Normalized Ratio
MH  - Male
MH  - Perioperative Care/*methods
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2004/05/28 05:00
MHDA- 2004/08/18 05:00
CRDT- 2004/05/28 05:00
PHST- 2004/05/28 05:00 [pubmed]
PHST- 2004/08/18 05:00 [medline]
PHST- 2004/05/28 05:00 [entrez]
AID - 10.1592/phco.24.6.649.34740 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2004 May;24(5):649-58. doi: 10.1592/phco.24.6.649.34740.