Low Molecular Weight versus Unfractionated Heparin

Abstract

Unfractionated heparin (UFH) has been in clinical use for over 50 years and extensive clinical trials have demonstrated its effectiveness in the prevention and treatment of thrombotic disease. In the last 2 decades, low molecular weight heparins (LMWHs) have been developed and subjected to extensive laboratory and clinical studies. In clinical comparison with UFH in the treatment of venous thromboembolism, LMWHs appear to offer a superior benefit-risk profile. In addition, the ease of drug administration and lack of drug monitoring associated with LMWHs are attractive clinical features. We calculated the overall costs of UFH and LMWH therapy using recently published clinical data and local cost information. Although the acquisition costs of LMWHs are higher than for UFH, LMWHs are more cost effective in surgical prophylaxis of deep venous thrombosis (DVT) if the costs of failed prophylaxis are considered. The costs of using subcutaneous (SC) LMWH as therapy for established DVT are lower than those of UFH administered by intravenous infusion. The financial benefit of using LMWH treatment becomes more pronounced when the rates of antithrombotic failure and bleeding complications are incorporated. If UFH is given by SC injection, however, the cost differential favouring LMWH for the treatment of DVT is not so great. If current trials demonstrate that LMWH treatment can be given on an ambulatory outpatient basis, the economic advantages of LMWH will be considerable. However, the extent of this will vary from place to place depending on local funding arrangements.

Transforming the Surgical "Time-Out" Into a Comprehensive "Preparatory Pause"

“…By increasing VTE prophylaxis from the national average of 50% to our rate (88%), we achieved prophylaxis in an additional 38 patients. Extrapolating from published data, 4‐6 we estimate that this enhanced prophylaxis might avoid as many as 15 DVTs per 100 patients. Medicare (ICD‐9 code 451.1) pays $1000 for a patient diagnosed with a DVT.…”

“…The clinical benefit and cost efficacy of perioperative DVT prophylaxis has been firmly established in moderate‐ and high‐risk patients 4,5 . The definition of DVT risk status is less clear.…”

“…The clinical benefit and cost efficacy of perioperative DVT prophylaxis has been firmly established in moderate-and high-risk patients. 4,5 The definition of DVT risk status is less clear. A recent comprehensive review updates the evidence-based algorithms, 6 but the subject remains complex.…”

Economic evaluation of the use of enoxaparin for thromboprophylaxis in acutely ill medical patients

“…This study differs from economic evaluations of VTE prophylaxis in surgical patients [3][4][5][6]8 in that we have explicitly included bleeding within the evaluation. Although no significant difference was found in the rate of major bleeding between enoxaparin and placebo therapy 13 , significantly lower rates are seen with LMWH compared with UFH 16 .…”

“…The clinical presentation of VTE comprises acute deep vein thrombosis (DVT) and pulmonary embolism (PE), along with the chronic sequelae of venous insufficiency and postthrombotic syndrome. The clinical benefit 2 and cost-effectiveness [3][4][5][6] of thromboprophylaxis in most moderate and high risk surgical groups have now been widely accepted into clinical practice, and may have led to a reduction in overall mortality from VTE 7 . However, the majority of hospitalised patients who suffer a fatal PE have not recently undergone surgery [7][8][9] , with up to one in 20 hospitalised medical patients who present with multiple problems and severe immobility suffering a fatal PE 10 .…”