Economic impact of an electronic alert system to prevent venous thromboembolism in hospitalised patients.

OBJECTIVES: The prevention of venous thromboembolism (VTE) is a priority for improved safety in hospitalised patients. Worldwide, there is growing concern over the undersuse of appropriate thromboprophylaxis. Computerised decision support improves the implementation of thromboprophylaxis and reduces inpatient VTE. However, an economic assessment of this approach has not yet been performed. OBJECTIVES: To evaluate the economic impact of an electronic alert (e-alert) system to prevent VTE in hospitalised patients over a 4year period. PATIENTS/METHODS: All hospitalised patients at a single institution during the first semesters of 2005-2009 (n=32280) were included. All cases of VTE developed during hospitalisation were followed and direct costs of diagnosis and management collected. RESULTS: E-alerts achieved a sustained reduction of the incidence of in-hospital VTE, OR 0.50 (95% CI, 0.29-0.84), the impact being especially significant in medical patients, OR 0.44 (95% CI, 0.22-0.86). No increase in prophylaxis-related bleeding was observed. In our setting, the mean direct cost (during hospitalisation and after discharge) of an in-hospital VTE episode is €7058. Direct costs per single hospitalised patient were reduced after e-alerts from €21.6 to €11.8, while the increased use of thromboprophylaxis and the development of e-alerts meant €3 and €0.35 per patient, respectively. Thus, the implementation of e-alerts led to a net cost saving of €6.5 per hospitalised patient. Should all hospitalised patients in Spain be considered, total yearly savings would approach €30million. CONCLUSIONS: E-alerts are useful and cost-effective tools for thromboprophylaxis strategy in hospitalised patients. Fewer thromboembolic complications and lower costs are achieved by its implementation.

Coagulación 2009: una visión moderna de la hemostasia / No disponible

Tras una lesión vascular se pone en marcha el mecanismo hemostático,un sistema de defensa del organismo para prevenir la hemorragia. Clásicamentese consideraba la coagulación como una cascada enzimáticacon 2 vías independientes, intrínseca y extrínseca, que convergían en unavía fi nal común. Dicho esquema no contemplaba la participación de lasplaquetas ni de otras superfi cies celulares. Según la visión actual, la coagulaciónse produce en tres etapas interrelacionadas: fases de iniciación,amplifi cación y propagación, y tiene lugar sobre superfi cies celulares, loque conlleva la formación de sufi cientes cantidades de trombina paraformar un coágulo estable capaz de detener la hemorragia(AU)

Folllowing vascular injury, blood loss is controlled by the mechanismof hemostasis. In a classic model of coagulation distinct intrinsic andextrinsic pathways converge on a common pathway. This scheme didnot take into account the participation of platelets nor other cellularcomponents. The concept has been challenged by a new one in whichcells are important participants in the coagulation process. In a modernview, the cell-based model of coagulation actually occurs in an overlappingstep-wise process: initiation, amplifi cation and propagation on thesurface of activated cells, to produce the burst of thrombin that causesstabilization of the fi brin clot and stop bleeding(AU)

Profi laxis del tromboembolismo venoso en pacientes hospitalizados con cáncer / No disponible

El tromboembolismo venoso (TEV), representado por la trombosis venosaprofunda (TVP) y el embolismo pulmonar (EP) es una causa frecuentede morbilidad y mortalidad asociada al cáncer, con un aumento delriesgo 4-6 veces superior al de la población general, que se incrementaen los pacientes hospitalizados. La profi laxis antitrombótica (heparinasde bajo peso molecular o pentasacárido, sólas o en combinación conmedidas físicas) debería considerarse de forma sistemática en estospacientes cuando concurren otros factores de riesgo de TEV (inmovilización,cirugía, quimioterapia), pero continúa siendo infrautilizada.Una estrategia de alerta activa y seguimiento de las guías clínicas detromboprofi laxis puede ayudar a reducir las graves consecuencias de latrombosis asociada al cáncer en pacientes hospitalizados(AU)

The association of cancer and venous thromboembolism (VTE), deepvenous thrombosis or pulmonay embolism, becomes increasingly importantin terms of morbidity and mortality, with an incidence 4-6-foldhigher than in the general population, being signifi cantly increased inhospitalized patients. Propohylaxis with low molecular weight heparinor pentasaccharide (alone or in combination with physical measures)should be considered in all hospitalized patients with risk factors forVTE (immobilization, surgery, chemotherapy). Despite clinical evidenceof effectiveness, prophylaxis is sill underused in these patients. An activealert strategy combined with guidelines prophylactic recommendationsmay help to prevent the serious consequences of cancer-associatedthrombosis in hospitalized patients(AU)

Profilaxis del tromboembolismo venoso en pacientes hospitalizados con cáncer / Prophylaxis of venous thromboembolism in hospitalized cancer patients

El tromboembolismo venoso (TEV), representado por la trombosis venosa profunda (TVP) y el embolismo pulmonar (EP) es una causa frecuente de morbilidad y mortalidad asociada al cáncer, con un aumento del riesgo 4-6 veces superior al de la población general, que se incrementaen los pacientes hospitalizados. La profi laxis antitrombótica (heparinas de bajo peso molecular o pentasacárido, sólas o en combinación conmedidas físicas) debería considerarse de forma sistemática en estos pacientes cuando concurren otros factores de riesgo de TEV (inmovilización,cirugía, quimioterapia), pero continúa siendo infrautilizada. Una estrategia de alerta activa y seguimiento de las guías clínicas de tromboprofi laxis puede ayudar a reducir las graves consecuencias de latrombosis asociada al cáncer en pacientes hospitalizados

The association of cancer and venous thromboembolism (VTE), deep venous thrombosis or pulmonay embolism, becomes increasingly important in terms of morbidity and mortality, with an incidence 4-6-fold higher than in the general population, being signifi cantly increased inhospitalized patients. Propohylaxis with low molecular weight heparin or pentasaccharide (alone or in combination with physical measures) should be considered in all hospitalized patients with risk factors forVTE (immobilization, surgery, chemotherapy). Despite clinical evidence of effectiveness, prophylaxis is sill underused in these patients. An active alert strategy combined with guidelines prophylactic recommendationsmay help to prevent the serious consequences of cancer-associated thrombosis in hospitalized patients (AU)

Tratamiento del síndrome antifosfolípido / Treatment of Antiphospholipid Syndrome

El síndrome antifosfolípido (SAF) se caracteriza por trombosis recurrentes y/o pérdidas fetales asociadas a la presencia de anticuerpos antifosfolípidos,anticoagulante lúpico, anticardiolipina y anti ß2-glicoproteína1. Los anticoagulantes orales (warfarina o sintrom) representan el tratamiento de elección para la prevención de recurrencia de trombosis venosa o arterial,por lo que estos pacientes deberían recibir este tratamiento a largo plazo, manteniendo INR = 2-3. Las heparinas de bajo peso molecular combinadas con dosis bajas de aspirina son una alternativa razonableen mujeres gestantes para evitar las pérdidas fetales y complicaciones obstétricas relacionadas con este síndrome

The antiphospholipid syndrome (APS) is a disorder of recurrent thrombosis and/or pregnancy loss associated with the presence of antiphospholipid antibodies and persistently positive lupus anticoagulant,anticardiolipin or anti ß2-glycoprotein1. Oral anticoagulants are the best available and most effective treatment for the secondary prevention of recurrent venous or arterial thrombosis. Patients with APS are treated with long-term therapy to prolong the INR to 2.0-3.0. Low-molecularweight heparin in combination with low-aspirin dose is a reasonable strategy to avoid pregnancy loss in women with this syndrome (AU)

[Treatment of antiphospholipid syndrome]. / Tratamiento del síndrome antifosfolípido.

The antiphospholipid syndrome (APS) is a disorder of recurrent thrombosis and/or pregnancy loss associated with the presence of antiphospholipid antibodies and persistently positive lupus anticoagulant, anticardiolipin or anti beta2-glycoprotein1. Oral anticoagulants are the best available and most effective treatment for the secondary prevention of recurrent venous or arterial thrombosis. Patients with APS are treated with long-term therapy to prolong the INR to 2.0-3.0. Low-molecular-weight heparin in combination with low-aspirin dose is a reasonable strategy to avoid pregnancy loss in women with this syndrome.