Key result
Outpatient enoxaparin bridging is linked to ~$900,000 in savings and over 1,100 bed days spared.
Why the study?
Traditional perioperative bridge therapy for patients interrupting long-term oral anticoagulation uses intravenous UFH, and whether an outpatient disease management strategy using LMWH could provide cost savings was uncertain.
Does outpatient perioperative bridge therapy with enoxaparin reduce costs and maintain safety in patients requiring temporary interruption of long-term warfarin?
Observational (n=84)
No
Does outpatient perioperative bridge therapy with enoxaparin reduce costs and maintain safety in patients requiring temporary interruption of long-term warfarin?
Outpatient perioperative bridge therapy with enoxaparin in patients on long-term warfarin reduces hospital bed days and yields significant cost savings without increasing thrombotic risk.
Answers are grounded in this paper and cite their sources.
May support cost savings with outpatient enoxaparin bridging; leaves open randomized confirmation of safety.
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 $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 $212,475/year in an integrated health maintenance organization. In addition, this strategy appears both safe and effective.
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Spyropoulos et al. (2004) conducted an observational in Temporary interruption of long-term oral anticoagulation (warfarin) for elective surgical procedures (n=84). Outpatient perioperative bridge therapy with enoxaparin (1 mg/kg twice/day subcutaneously) vs. Traditional inpatient weight-adjusted intravenous unfractionated heparin (UFH) was evaluated on Cost savings, hospital bed days saved, thrombotic events, and major hemorrhagic events. Outpatient perioperative enoxaparin bridging saved 1,108 hospital bed days and ~$903,020 over 4.25 years ($212,475/year), with 0 thrombotic and 3 major hemorrhagic events in 126 encounters.
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