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Anticoagulation for noncardiac procedures in patients with prosthetic heart values: does low risk mean high cost?

Article Abstract:

Patients who have prosthetic heart valves often require continuous anticoagulation therapy to prevent blood clots from forming. This may pose a problem if a cardiac surgical procedure is needed. Anticoagulation therapy is normally discontinued between one and five days prior to surgery. These surgery patients must then be frequently kept in the hospital for observation after surgery because of an increased risk of developing a thromboembolism, a blood clot that causes blockage of a blood vessel. This practice is both time-consuming and costly: the period of increased risk is relatively short, and the incidence of thromboembolic events is rather low. This study evaluated the cost-effectiveness of various treatment alternatives, examining the cost of prolonged hospitalization for heparin treatment and other therapies. Other factors considered were the costs of averting deaths and thromboembolic episodes in patients with heart valves, who are at increased risk for death or illness from thromboembolic events. In general, researchers concluded that the cost of prolonged hospitalization for these patients is not justified when compared with the actual average number of deaths averted and the incidence of thromboembolism prevented by this procedure. It was determined that if heparin, an anticoagulant, can be resumed within one to two days following surgery, the patient normally will not require a prolonged hospital stay. In patients with valves that cause frequent incidents of thromboembolism, a third day of inpatient heparin therapy may be wise. Heparin injection treatments in the home reflect a current trend in treatment, but may not be much more cost-effective than prolonged hospitalization. The decision on how to therapeutically proceed always depends on the individual patient. One influential factor is the type of heart valve the patient has; various individualized approaches are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Safety and security measures, Prevention, Complications and side effects, Physiological aspects, Surgery, Postoperative complications, Thromboembolism, Cardiac patients, Heparin, Heart valve prosthesis, Artificial heart valves

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Foot infections in diabetic patients: decision and cost-effectiveness analyses

Article Abstract:

Treating foot infections in diabetic patients with surgical debridement followed by oral antibiotic therapy appears to be as effective and less expensive than other treatments. Foot infections are a common complication of diabetes, and they can lead to osteomyelitis (bone inflammation) that may need to be treated with amputation. Surgical debridement involves cutting away infected tissue and cleaning a wound. Researchers used a computer model to analyze treatment strategies in relation to cost and quality-adjusted life expectancy. Treatment strategies included both short and long courses of antibiotics after debridement, diagnostic tests including imaging, laboratory tests and biopsy, and immediate amputation. Expensive and invasive tests did not appear to give any advantage in improved survival or quality of life. The best option in terms of cost-effectiveness was culturing the debrided tissue to identify the infecting organism and treating with an appropriate antibiotic for 10 weeks.

Infection, Economic aspects, Type 2 diabetes, Foot, Osteomyelitis

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Effect of laboratory variation in the prothrombin-time ratio on the results of oral anticoagulant therapy

Article Abstract:

Unknown sensitivity of commercial thromboplastins may affect the outcome of patients receiving long-term treatment with anticoagulants. Thromboplastin is a substance used to measure prothrombin time in patients treated with anticoagulants. Prothrombin time is a measurement used to evaluate the risk of bleeding episodes or obstruction of a blood vessel. Researchers examined the effect of uncertainty about thromboplastin sensitivity in patients with an artificial heart valve. Patients benefited significantly from treatment with anticoagulants in the recommended range of the international normalized ratio. The risks associated with long-term treatment increased with uncertainty about thromboplastin sensitivity. This type of uncertainty may cause the intensity of the anticoagulation to fall outside the recommended range. This increases the risk of life-threatening complications.

Usage, Measurement, Thromboplastin, Partial thromboplastin time, Prothrombin time

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