Outcomes and total costs of outpatient vs. inpatient peri-procedural anticoagulation management of mechanical prosthetic heart valve patients.
Outcomes and total costs of outpatient vs. inpatient peri-procedural anticoagulation management of mechanical prosthetic heart valve patients.
复制标题
机械人工心脏瓣膜患者门诊与住院围手术期抗凝管理的结果和总成本。
DOI：
10.1016/j.ijcard.2013.08.010
复制
发表时间：
2013
影响因子：
3.5
通讯作者：
McBane2nd,RobertD
中科院分区：
文献类型：
--
作者：
Attaya,Hosam;Shah,NilayD;Wysokinski,WaldemarE;VanHouten,HollyK;Heit,JohnA;McBane2nd,RobertD
背景/目的对机械心脏瓣膜(MHV)患者的围手术期最经济有效的管理尚不确定。目的是比较住院静脉注射普通肝素(IVUH)和门诊低分子肝素(LMWH)作为围手术期抗凝治疗MHV患者的有效性、安全性和成本。方法在奥姆斯特县的一项病例队列研究中，将1997-2007年间接受门诊围手术期低分子肝素治疗的MHV患者与接受住院IVUH围术期管理的MHV患者在瓣膜位置、类型和手术类型上进行配对。入院后对患者进行3个月的随访，以确定血栓栓塞症(TE)和大出血。从手术前30天到手术后90天的总费用是从奥姆斯特德县医疗支出和利用数据库确定的。用生存分析比较结果，用Wilcoxon秩和比较费用。结果14 9例患者(主动脉10 0例，二尖瓣2 9例，双叶2 0例；%的双叶瓣)与149例队列成员(主动脉10 0例，二尖瓣2 9例，两者均2 0例；双叶瓣占75%)进行了比较。虽然TE的3个月累积发生率在病例(2.7%)和队列成员(4.7%；p=0.36)之间没有显著差异，但病例中的大出血发生率(5.4%vs.15.4%；p<；0.005)显著较低。队列成员的总费用显著较高(50,984美元对39,347美元；p=0.002)，因为较高的住院费用(47,729美元对34,860美元；p=0.0002)。结论门诊桥式低分子肝素治疗MHV患者围术期抗凝效果与住院患者IVUH相同，但更安全、费用更低。
Background/objectives The most cost-effective periprocedural management of patients with mechanical heart valves (MHV) is uncertain. The objective was to compare the effectiveness, safety and costs for inpatient intravenous unfractionated heparin (IVUH) vs. outpatient low molecular weight heparin (LMWH)“bridging” as periprocedural anticoagulation management for MHV patients. Methods In a case-cohort study, Olmsted County, MN residents with MHV who received outpatient periprocedural LMWH management (cases) over the 11-year period, 1997–2007, were matched to residents with MHV who received inpatient IVUH periprocedural management on valve location and type, and on procedure type. Patients were followed for 3 months following hospitalization to identify thromboembolism (TE) and major bleeding. Total costs from 30 days before to 90 days after the procedure were determined from the Olmsted County Healthcare Expenditure and Utilization Database. Outcomes were compared using survival analysis and costs were compared using the Wilcoxon rank sum. Results 149 cases (100 aortic, 29 mitral, 20 both; 64% bileaflet) were compared to 149 cohort members (100 aortic, 29 mitral, 20 both; 75% bileaflet). While the 3-month cumulative incidence of TE did not differ significantly among cases (2.7%) and cohort members (4.7%; p= 0.36), major bleeding was significantly lower in cases (5.4% vs. 15.4%; p< 0.005). Total costs were significantly higher for cohort members ($50,984 vs. $39,347; p= 0.002) due to higher inpatient costs ($47,729 vs. $34,860; p= 0.0002). Conclusions Outpatient bridging LMWH therapy is equally effective, but safer and less costly than inpatient IVUH as periprocedural anticoagulation management for MHV patients.