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          Graphic - cost of major bleeding.

          What are the costs when your patients have major bleeding episodes?

          Blood clot prevention

          Featured expert

          William Nadeau Medical Affairs Manager, Cardinal Health

          William Nadeau, MS, RD

          Medical Affairs Director, Cardinal Health

          Hospital-acquired venous thromboembolism (HA-VTE) is a common, costly and preventable hospital complication.

          Graphic of blood flowing through vein.

          $15,000

          Estimated cost per hospital-acquired venous thromboembolism, which encompasses deep vein thrombosis (DVT) and pulmonary embolism.
          There is a $15,000 estimated cost per HA-VTE, which encompasses deep vein thrombosis (DVT) and pulmonary embolism. An estimated 100,000 Americans die each year from VTE. In many cases this suffering can be prevented through interventions such as intermittent pneumatic compression (IPC) devices, early mobilization and pharmacologics like low molecular weight heparin (LMWH).

          Bleeding is a potential complication associated with the use of pharmacological prevention for VTE.

          Graphic - syringe in circle.

          2.9%

          Rate of major bleeding* with rivaroxaban.
          (retrospective, hip and knee)

          Graphic - syringe in circle.

          3.9%

          Receiving rivaroxaban and requiring re-operation due to wound complications.4
          (hip and knee)

          Graphic - syringe in circle.

          7.0%

          Rate of major bleeding* with LMWH.
          (retrospective, hip and knee)

          Graphic - patient with blood on arm in circle.

          7x

          7-fold higher risk of death among patients with a major bleeding** event within 30 days.****
          (8 randomized controlled trials, surgical and medical)

          $11,000 Estimated cost per DVT with major bleeding*** event6

           

          IPC can be seen as a cost-saving in the prevention of VTE after general surgery1

          Graphic - nurse putting compression sleeves on patient.

          $113 cost saving per patient2

          Treating post-operative general surgery patients with moderate to high risk of VTE with IPC

          A cost effectiveness model for patients was created with moderate to high risk of VTE after general surgery. It compared two hypothetical groups of 1000 patients treated with IPC plus graduated compression stockings (GCS) or no prophylaxis. The primary endpoints included cost of treating VTE and cost of prophylaxis per 1000 patients.1

          Graphic - VTE cost savings.

          References:

          1. Nicolaides, A., Goldhaber, S. Z., Maxwell, G. L., Labropoulos, N., Clarke-Pearson, D. L., Tyllis, T. H., & Griffin, M. B. (2008). Cost benefit of intermittent pneumatic compression for venous thromboembolism prophylaxis in general surgery. Int Angiol, 27(6), 500-506.
          2. Meta-analysis of 11 trials evaluating IPC plus GCS to no prophylaxis. The model assumed VTE rates as demonstrated in meta-analysis of 54 randomized controlled trials. Clagett, G. P., & Reisch, J. S. (1988). Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg, 208(2), 227-240.
          3. Beyer-Westendorf, J., Lutzner, J., Donath, L., Tittl, L., Knoth, H., Radke, O. C., . . . Werth, S. (2013). Efficacy and safety of thromboprophylaxis with low-molecular-weight heparin or rivaroxaban in hip and knee replacement surgery: findings from the ORTHO-TEP registry. Thromb Haemost, 109(1), 154-163. doi: 10.1160/th12-07-0510.
          4. Jensen, C. D., Steval, A., Partington, P. F., Reed, M. R., & Muller, S. D. (2011). Return to theatre following total hip and knee replacement, before and after the introduction of rivaroxaban: a retrospective cohort study. J Bone Joint Surg Br, 93(1), 91-95. doi: 10.1302/0301-620x.93b1.24987
          5. Eikelboom, J. W., Quinlan, D. J., & O'Donnell, M. (2009). Major bleeding, mortality, and efficacy of fondaparinux in venous thromboembolism prevention trials. Circulation, 120(20), 2006-2011. doi: 10.1161/circulationaha.109.872630
          6. O'Brien, J. A., & Caro, J. J. (2002). Direct medical cost of managing deep vein thrombosis according to the occurrence of complications. Pharmacoeconomics, 20(9), 603-615.

          Definitions of major bleeding:

          • *Overt bleeding including large wound hematoma with either: a documented transfusion of at least two units of RBC, a surgical revision due to bleeding or, a bleeding into critical site (intracranial, intraocular, intraarticular, retroperitoneal, overt gastrointestinal bleeding), or fatal bleeding.
          • ** At 30 days, the risk of death was 7-fold higher among patients with a major bleeding event (8.6% versus 1.7%; adjusted hazard ratio, 6.96; 95% confidence interval, 4.60 to 10.51). There was a consistent pattern of reduced mortality in patients treated with fondaparinux irrespective of whether patients experienced major bleeding (6.8% versus 11.4%; hazard ratio, 0.58; 95% confidence interval, 0.27 to 1.23) or no major bleeding (1.5% versus 1.9%; hazard ratio, 0.77; 95% confidence interval, 0.59 to 1.02; P for heterogeneity=0.47).
          • ***Includes any one of the following: hemorrhage due to circulating anticoagulants; subarachnoid, intracerebral or subdural hemorrhage; unspecified hemorrhage; or gastrointestinal hemorrhage.
          • ****Includes patients undergoing hip fracture surgery, hip replacement surgery, major knee surgery, abdominal surgery, or acutely ill high-risk medical patients receiving fondaparinux, LMWH, or placebo for VTE prophylaxis.

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