Costs and Clinical Outcomes Associated With Low-Molecular-Weight Heparin vs Unfractionated Heparin for Perioperative Bridging in Patients Receiving Long-term Oral Anticoagulant Therapy

Spyropoulos, Alex C.; Frost, Floyd J.; Hurley, Judith S.; Roberts, Melissa M.

doi:10.1378/chest.125.5.1642

Cited by 100 publications

(60 citation statements)

References 23 publications

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“…Spyropoulos et al performed a retrospective analysis of costs and clinical outcomes associated with LMWH for perioperative bridging in patients receiving long-term oral anticoagulant therapy (966). The mean total healthcare costs in the perioperative period were significantly lower (by $13 114) in patients receiving long-term oral anticoagulant therapy with LMWH than in those receiving it with UFH for an elective surgical procedure.…”

Section: Excessive Anticoagulationmentioning

confidence: 99%

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2006

Circulation

3,246

813

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Section: Excessive Anticoagulationmentioning

confidence: 99%

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2006

Circulation

3,246

813

View full text Add to dashboard Cite

“…966 The mean total healthcare costs in the perioperative period were significantly lower (by $13 114) in patients receiving long-term oral anticoagulant therapy with LMWH than in those receiving it with UFH for an elective surgical procedure. The cost savings associated with LMWH use were accomplished through the avoidance or minimization of inpatient stays and no increase in the overall rate of clinical adverse events in the postoperative period.…”

Section: Excessive Anticoagulationmentioning

confidence: 97%

“…The cost savings associated with LMWH use were accomplished through the avoidance or minimization of inpatient stays and no increase in the overall rate of clinical adverse events in the postoperative period. 966 For patients with a bileaflet mechanical aortic valve and no risk factors, warfarin should be stopped before the procedure so that the INR is less than 1.5 (which is often 48 to 72 h after warfarin is discontinued) 934,967 and restarted within 24 h after a procedure. Admission to the hospital or a delay in discharge to give heparin is usually unnecessary.…”

Section: Excessive Anticoagulationmentioning

confidence: 99%

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2008

Circulation

910

259

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“…9,10 In fact, although pharmacy costs are higher with LMWH, total healthcare costs are significantly lower in the LMWH-bridged group through avoidance or minimization of hospital stays and no overall increase of adverse events. 11 Bridging therapy is more readily accepted in high-thromboembolic-risk patients, 7,12 whereas methods for managing low-and intermediate-risk patients range from a minimalist strategy involving suspension of oral anticoagulant without administration of heparin 13 to an aggressive bridging with therapeutic doses of LMWH. 2,14 Clinical Perspective on p 2927…”

mentioning

confidence: 99%

Standardized Low–Molecular-Weight Heparin Bridging Regimen in Outpatients on Oral Anticoagulants Undergoing Invasive Procedure or Surgery

Cucchini²,

et al. 2009

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Background-Bridging therapy with low-molecular-weight heparin is usually recommended in patients who must stop oral anticoagulants before surgical or invasive procedures. To date, there is no universally accepted bridging regimen tailored to the patient's thromboembolic risk. This prospective inception cohort management study was designed to assess the efficacy and safety of an individualized bridging protocol applied to outpatients. Methods and Results-Oral anticoagulants were stopped 5 days before the procedure. Low-molecular-weight heparin was started 3 to 4 days before surgery and continued for 6 days after surgery at 70 anti-factor Xa U/kg twice daily in high-thromboembolic-risk patients and prophylactic once-daily doses in moderate-to low-risk patients. Oral anticoagulation was resumed the day after the procedure with a boost dose of 50% for 2 days and maintenance doses afterward. The patients were followed up for 30 days. Of the 1262 patients included in the study (only 15% had mechanical valves), 295 (23.4%) were high-thromboembolic-risk patients and 967 (76.6%) were moderate-to low-risk patients. In the intention-to-treat analysis, there were 5 thromboembolic events (0.4%; 95% confidence interval, 0.1 to 0.9), all in high-thromboembolic-risk patients. There were 15 major (1.2%; 95% confidence interval, 0.7 to 2.0) and 53 minor (4.2%; 95% confidence interval, 3.2 to 5.5) bleeding episodes. Major bleeding was associated with twice-daily low-molecular-weight heparin administration (high-risk patients) but not with the bleeding risk of the procedure. Conclusions-This management bridging protocol, tailored to patients' thromboembolic risk, appears to be feasible, effective, and safe for many patients, but safety in patients with mechanical prosthetic valves has not been conclusively established.

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Costs and Clinical Outcomes Associated With Low-Molecular-Weight Heparin vs Unfractionated Heparin for Perioperative Bridging in Patients Receiving Long-term Oral Anticoagulant Therapy

Cited by 100 publications

References 23 publications

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Standardized Low–Molecular-Weight Heparin Bridging Regimen in Outpatients on Oral Anticoagulants Undergoing Invasive Procedure or Surgery

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