Bergqvist D, Lindgren B, Mätzsch T
Department of Surgery, University Hospital, Uppsala, Sweden.
Br J Surg. 1996 Nov;83(11):1548-52. doi: 10.1002/bjs.1800831117.
The relative costs were analysed of (1) no prophylaxis against deep vein thrombosis (DVT), (2) selective treatment of DVT after confirmation of diagnosis, (3) general prophylaxis with standard low-dose unfractionated heparin and (4) general prophylaxis with low molecular weight heparin (LMWH) in patients undergoing elective general abdominal surgery or elective hip surgery. The mean calculated costs per patient undergoing general abdominal surgery were: Swedish crowns (SEK) 1950 for no prophylaxis, SEK 5710 for selective treatment of DVT, SEK 735 for prophylaxis with unfractionated heparin and SEK 665 for prophylaxis with LMWH. The corresponding costs for hip surgery were SEK 3930, SEK 10790, SEK 1730 and SEK 1390 respectively. Thus, the least expensive management strategy in patients undergoing elective general abdominal or hip surgery would appear to be general prophylaxis with either unfractionated heparin or LMWH. Furthermore, general prophylaxis with LMWH would appear to be more cost-effective than general prophylaxis with unfractionated heparin.
（1）不对深静脉血栓形成（DVT）进行预防；（2）确诊后对DVT进行选择性治疗；（3）采用标准低剂量普通肝素进行一般预防；（4）对接受择期普通腹部手术或择期髋关节手术的患者采用低分子量肝素（LMWH）进行一般预防。接受普通腹部手术的每位患者的平均计算成本为：不进行预防为1950瑞典克朗（SEK），DVT选择性治疗为5710瑞典克朗，普通肝素预防为735瑞典克朗，LMWH预防为665瑞典克朗。髋关节手术的相应成本分别为3930瑞典克朗、10790瑞典克朗、1730瑞典克朗和1390瑞典克朗。因此，对于接受择期普通腹部手术或髋关节手术的患者，最便宜的管理策略似乎是采用普通肝素或LMWH进行一般预防。此外，LMWH进行一般预防似乎比普通肝素进行一般预防更具成本效益。
