Hull R D, Hirsh J, Sackett D L, Stoddart G L
Can Med Assoc J. 1982 Nov 15;127(10):990-5.
Because death due to pulmonary embolism is relatively rare following general surgery, many question the need for prophylaxis. In addition, there has been reluctance to apply new interventions whose cost-effectiveness has not been adequately evaluated. A cost-effectiveness analysis based on over 1000 high-risk patients undergoing abdominothoracic surgery, with effectiveness measured in terms of numbers of deaths from pulmonary embolism averted, has shown subcutaneous administration of heparin in low doses starting 2 hours before the operation to be the most cost-effective of several active approaches to prophylaxis. It averted seven of the eight deaths expected without active prophylaxis per 1000 such patients and cost half as much as the traditional approach of intervening only when venous thromboembolism becomes clinically apparent. Intravenous administration of dextran, although effective, was expensive, and leg scanning with iodine-125-labelled fibrinogen was extremely expensive. Intermittent pneumatic compression of the legs was inexpensive, but, as with leg scanning, its effectiveness has not been determined in randomized trials.
由于普通外科手术后因肺栓塞导致的死亡相对较少，许多人质疑预防的必要性。此外，人们一直不愿意采用那些成本效益尚未得到充分评估的新干预措施。一项基于1000多名接受胸腹手术的高危患者的成本效益分析表明，以避免肺栓塞死亡人数来衡量有效性，在手术前2小时开始皮下注射低剂量肝素是几种积极预防方法中最具成本效益的。每1000名此类患者中，它避免了预期的8例死亡中的7例，且成本仅为传统方法（仅在静脉血栓栓塞出现临床症状时才进行干预）的一半。静脉注射右旋糖酐虽然有效，但成本高昂，而用碘-125标记的纤维蛋白原进行腿部扫描则极其昂贵。间歇性腿部充气压迫成本低廉，但是，与腿部扫描一样，其有效性尚未在随机试验中得到确定。
