Murray R D, Deitcher S R, Shah A, Jasper S E, Bashir M, Grimm R A, Klein A L
Department of Cardiology, Cardiovascular Imaging Center; the Department of Vascular Medicine, Clinical Thrombosis Section; and Biostatistics and Epidemiology; The Cleveland Clinic Foundation.
J Am Soc Echocardiogr. 2001 Mar;14(3):200-8. doi: 10.1067/mje.2001.109505.
An alternative clinical management strategy and cost analysis model is presented for patients with atrial fibrillation of >2 days' duration who may benefit from immediate cardioversion with self-administered low-molecular-weight heparin (enoxaparin) as a bridge antithrombotic therapy to warfarin, after a negative transesophageal echo-cardiography (TEE) screening for thrombus. Assuming no difference in stroke or bleeding rates, our cost minimization model shows that the TEE-guided enoxaparin treatment costs are $1353 lower per patient than an intravenous unfractionated heparin approach. Sensitivity analyses for stroke and bleeding reveal that the treatment-cost economic dominance of the TEE-guided enoxaparin approach may be enhanced by an expected improvement in clinical outcome.
对于持续时间超过2天的房颤患者，本文提出了一种替代临床管理策略和成本分析模型。这些患者在经食管超声心动图（TEE）血栓筛查为阴性后，可能受益于立即复律，并使用自我注射的低分子量肝素（依诺肝素）作为华法林的桥接抗栓治疗。假设中风或出血率无差异，我们的成本最小化模型显示，与静脉注射普通肝素的方法相比，TEE引导的依诺肝素治疗每位患者的成本低1353美元。对中风和出血的敏感性分析表明，临床结果的预期改善可能会增强TEE引导的依诺肝素方法在治疗成本方面的经济优势。
