Cost-saving approach to patients on long-term anticoagulation who need endoscopy: a decision analysis

Mathew, Abraham; Riley III, Thomas R.; Young, Mark; Ouyang, Ann
August 2003
American Journal of Gastroenterology;Aug2003, Vol. 98 Issue 8, p1766
Academic Journal
: ObjectiveThe management strategies used when patients requiring long-term anticoagulation need endoscopic procedures vary considerably. Two commonly used approaches are a “heparin window” strategy in the inpatient setting and, more recently, a “switch to low molecular weight heparin (LMWH)” strategy for elective procedures. The aim of this study was to determine whether an initial diagnostic endoscopy (visualization only) is a cost-effective strategy in these patients.: MethodsDecision analysis was performed for two scenarios using probability estimates from our retrospective study. Scenario 1: Patients with any (urgent and elective) indication for endoscopy while on anticoagulation. A decision tree was made outlining two strategies: 1) a diagnostic endoscopy on full anticoagulation followed by therapeutic endoscopy if needed using standard practice; and 2) standard approach. Scenario 2: Patients requiring elective endoscopy. Here, the decision tree outlined three strategies: 1) initial diagnostic endoscopy on full anticoagulation followed by a therapeutic endoscopy if needed using a “heparin window”; 2) initial diagnostic endoscopy followed by therapeutic endoscopy if needed using “switch to LMWH” strategy; and 3) “direct switch to LMWH strategy.”: ResultsInitial diagnostic endoscopy is the preferred strategy when patients requiring anticoagulation need endoscopy. In scenario 1 (all patients), the diagnostic endoscopy approach will reduce need for hospital stay and save $85,006 per 100 patients when a therapeutic impact is not predictable before endoscopy. Similarly, in scenario 2, an initial diagnostic endoscopy followed by switch to LMWH strategy is the most cost saving.: ConclusionsIn anticoagulated patients, an initial diagnostic endoscopy approach on anticoagulation is the most cost-saving strategy, when a direct therapeutic impact is not predictable.


Related Articles

  • Educating patients in self-management of epistaxis in an anticoagulation clinic. Hassenplug, Karen L.; Burkiewicz, Jill S.; Jackson, Terri L.; Peppers, Laura R. // American Journal of Health-System Pharmacy;5/15/2006, Vol. 63 Issue 10, p909 

    The article focuses on a survey which evaluated the effect of pharmacist education on self-management of epistaxis for patients treated with anticoagulants. The survey was designed to assess the effect of pharmacist-provided education on knowledge of proper epistaxis management among patients...

  • Recognition and Management of Pulmonary Hypertension. Wanstall, J.C.; Jeffery, T.K. // Drugs;Dec1998, Vol. 56 Issue 6, p989 

    Pulmonary hypertension (mean pulmonary arterial pressure >20mm Hg at rest or >30mm Hg during exercise) occurs (i) as primary pulmonary hypertension (no known underlying cause), (ii) as persistent pulmonary hypertension of the newborn or (iii) secondary to a variety of lung and cardiovascular...

  • THE MANAGEMENT OF SEVERE HEMATURIA AND CLOT RETENTION. Miles-Thomas, Jennifer; Allaf, Mohammad E. // Contemporary Urology;Dec2007, Vol. 19 Issue 12, p32 

    The article discusses severe hematuria and clot retention management. A brief overview of hematuria is presented. Hematuria may be caused by bladder and upper tract malignancies, prostatic bleeding, anticoagulant use and radiation and infectious cystitis. The use of bladder irrigation,...

  • Transient basilar artery occlusion monitored by transcranial color Doppler presenting with a spectacular shrinking deficit: a case report. Nicoletti, Giuseppe; Albano, Gerardina; Sanguigni, Sandro; Tardi, Salvatore; Malferrari, Giovanni; Sette, Massimo Del; Bruno, Filomena; Nicolai, Aldo // Journal of Medical Case Reports;2010, Vol. 4 Issue 1, p1 

    Introduction: We describe the case of a 79-year-old Caucasian Italian woman with a transient basilar occlusion monitored by transcranial Doppler, with subsequent recanalization and clinical shrinking deficit. This is the first case of transient basilar occlusive disease diagnosed and monitored...

  • STANDARD MANAGEMENT OF VENOUS THROMBOSIS. Hume, Michael // Vascular Surgery;Jul/Aug1977, Vol. 11 Issue 4, p197 

    Discusses the standard management of thrombosis. Purpose of physical examinations; Objectives of standard therapy with anticoagulant drugs; Advantage of warfarin therapy.

  • Maintaining rhythm in atrial fibrillation. Sherman, Carl // Cortlandt Forum;Jan2007, Vol. 20 Issue 1, p70 

    The article provides information on the revised guidelines for management of patients with atrial fibrillation (AF). The guidelines enable to strengthen and to clarify previous recommendations based on the outcomes of major clinical trials published in the intervening years. The guidelines still...

  • Undue Extension of Hospital Stay Associated With Anticoagulation. Deitcher, Steven R. // Mayo Clinic Proceedings;Feb2004, Vol. 79 Issue 2, p157 

    Editorial. Discusses the relationship between oral anticoagulation with the use of warfarin sodium and long-term outpatient management related to thrombotic and vascular disorders. Suitability of Warfarin for primary thromboprophylaxis in patients with atrial fibrillation; History of parental...

  • Standardizing the management of heparin-induced thrombocytopenia. Fugate, Susan; Chiappe, Julia // American Journal of Health-System Pharmacy;2/15/2008, Vol. 65 Issue 4, p334 

    The article presents a case study on the implemented treatment protocol for management of patients who are suffering from heparin-induced thrombocytopenia (HIT). Medical records of patients who were suffering and suspected of HIT complication had undergone extensive evaluation to determine the...

  • Why differentiate low molecular weight heparins for venous thromboembolism? Fareed, Jawed; Walenga, Jeanine M. // Thrombosis Journal;2007, Vol. 5, p1 

    The author reflects on the differentiation of low molecular weight heparins (LMWHs) for venous thromboembolism. According to the author, LMWHs have become the standard of care for the management of venous thromboembolism among all anticoagulants developed in the past years. However, the author...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics