PMID- 18034323
OWN - NLM
STAT- MEDLINE
DCOM- 20090107
LR  - 20211020
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 26
IP  - 2
DP  - 2008 Oct
TI  - Cost and occurrence of thrombocytopenia in patients receiving venous 
      thromboembolism prophylaxis following major orthopaedic surgeries.
PG  - 125-31
AB  - BACKGROUND: Many factors impact the choice of anticoagulant used for venous 
      thromboembolism prophylaxis following orthopaedic surgery. Thrombocytopenia (TCP) 
      is an important factor from both clinical and economic perspectives, warranting 
      assessment between the available agents. Thus, a retrospective cohort analysis 
      was conducted to: (1) report the occurrence of TCP in a treatment and no 
      treatment group, (2) evaluate the impact of anticoagulant choice on TCP within 
      the treatment group, and (3) assess the clinical and economic implications of TCP 
      in the treatment group. METHODS: Administrative claims from a hospital database 
      were used to identify patients with hip replacement, knee replacement, or hip 
      fracture surgery. The treatment group (n = 144,806) included patients receiving 
      one of the following injectable anticoagulants post-operatively: dalteparin (n = 
      16,109); enoxaparin (n = 97,827); fondaparinux (n = 12,532); or unfractionated 
      heparin (UFH) (n = 18,338). The no treatment group consisted of patients who did 
      not receive one of the four injectable anticoagulants (n = 112,574) 
      post-operatively. Outcomes were assessed for the hospitalization period plus 2 
      months post-discharge while controlling for relevant demographic and clinical 
      characteristics. RESULTS: The occurrence of TCP was 1.0% in the no treatment 
      group and 1.7% in the treatment group. Within the treatment group, patients who 
      received dalteparin, enoxaparin, and UFH were significantly more likely to 
      experience coded thrombocytopenia than those in the no treatment group. The risk 
      of TCP among patients who received fondaparinux was not significantly different 
      from the no treatment cohort (odds ratio [OR] = 1.15, 95% CI: 0.96-1.37, P = 
      0.13). Patients in the treatment group with coded TCP had 22% higher adjusted 
      mean total healthcare costs (relative cost difference) compared to those without 
      ($19,134 vs. $15,400, respectively, P < 0.0001), greater mean length of stay 
      (LOS) (8.4 vs. 5.7, respectively), and a greater likelihood of experiencing a 
      venous thromboembolic (VTE) event (6.1% vs. 2.4%, respectively). CONCLUSION: 
      Patients treated with fondaparinux did not have a significant increase in the 
      risk of TCP compared to patients not on prophylaxis. In contrast, the risk was 
      increased in those treated with enoxaparin, dalteparin, and UFH compared to the 
      patients not on prophylaxis. Patients in the treatment group with coded TCP 
      experienced more thrombotic events, incurred greater per patient healthcare 
      costs, and experienced longer LOS than patients without coded TCP. Therefore, the 
      risk of TCP should be considered when evaluating the profile of injectable 
      anticoagulants since TCP may have important clinical and economic implications.
FAU - Happe, Laura Elizabeth
AU  - Happe LE
AD  - Xcenda, 4114 Woodlands Parkway, Suite 500, Palm Harbor, FL, 34685, USA. 
      LHappe@xcenda.com
FAU - Farrelly, Eileen Marie
AU  - Farrelly EM
FAU - Stanford, Richard H
AU  - Stanford RH
FAU - Sarnes, Matt William
AU  - Sarnes MW
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20071124
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Polysaccharides)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/administration & dosage/*adverse effects
MH  - Cohort Studies
MH  - Dalteparin/adverse effects
MH  - Enoxaparin/therapeutic use
MH  - Female
MH  - Fondaparinux
MH  - Health Care Costs
MH  - Heparin/adverse effects
MH  - Humans
MH  - Incidence
MH  - Injections
MH  - Length of Stay
MH  - Male
MH  - Odds Ratio
MH  - *Orthopedic Procedures/adverse effects/economics
MH  - Polysaccharides/adverse effects
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - *Thrombocytopenia/chemically induced/economics/epidemiology
MH  - Venous Thromboembolism/etiology/*prevention & control
EDAT- 2007/11/24 09:00
MHDA- 2009/01/08 09:00
CRDT- 2007/11/24 09:00
PHST- 2007/04/13 00:00 [received]
PHST- 2007/11/07 00:00 [accepted]
PHST- 2007/11/24 09:00 [pubmed]
PHST- 2009/01/08 09:00 [medline]
PHST- 2007/11/24 09:00 [entrez]
AID - 10.1007/s11239-007-0170-1 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2008 Oct;26(2):125-31. doi: 10.1007/s11239-007-0170-1. 
      Epub 2007 Nov 24.