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Research article
María Victoria Cuevas
Hospital Universitario de Burgos
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7991-1234
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
We analyze the cost of an incorrect application, by the hematologist, of bridging anticoagulation in patients with low-risk atrial fibrillation (AF) needing interruption of treatment prior to a scheduled invasive procedure. Although not recommended, bridging therapy is widely used, resulting in avoidable costs and increased workload.
Methods
Observational retrospective study. We recorded demographic and clinical data including age, sex, type of procedure, use of bridging therapy with low molecular weight heparin (LMWH), and hemorrhagic complications within 30 days of acenocoumarol withdrawal.
Results
Acenocoumarol was stopped in 161 patients, 97 (60%) were male and 64 (40%) female. Average age was 76,11 ± 8,45 years. Procedures included: minor surgical intervention 58 (36%), colonoscopy 61 (38%), gastroscopy 11 (7%), breast biopsy 4 (2.5%), prostate biopsy 4 (2.5%), infiltration 5 (3%), and other 18 (11%). All patients received bridging anticoagulation with LMWH (40mg enoxaparin per day) 3 days before and 3 days after the procedure (6 doses). We used a total of 966 doses, at €4.5 per unit, resulted in €4,347 of total cost. No complications occurred in 156 patients (97%). Hemorrhage was observed in 5 cases: 1 major hemorrhage needing 6 days of hospital stay and transfusion, and 4 minor hemorrhages (2 patients needed Emergency attendance and 2 required hospital admission for 3 and 2 days, respectively). The cost of Emergency care was €237.36, and the cost of hospital stay was €6860.81 (€623.71 per day, for 11 days). The total cost of the incorrect application of the protocol was €11445.17.
Conclusion
Guidelines about bridging anticoagulation in low risk AF patients undergoing scheduled invasive procedures were not followed. This practice increments the complications and supposes an increase in costs besides to an inadequate use of the human resources.
Keywords
Atrial fibrillation; Bridging therapy; Guidelines; Avoidable costs; Workload.
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
No community comments so far
Submission checks complete
On 07 Nov, 2019
Editorial decision: Accept
On 21 Oct, 2019
Editor assigned
On 20 Oct, 2019
Editor invited
On 19 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 18 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 17 Oct, 2019
Editor assigned
On 27 Sep, 2019
Submission checks complete
On 26 Sep, 2019
Editor invited
On 26 Sep, 2019
Version 1
Posted 20 Aug, 2019
No comments provided
Editorial decision: Major revision
On 19 Sep, 2019
Review #2 received
Received 18 Sep, 2019
Review #1 received
Received 15 Sep, 2019
Reviewer #2 agreed
On 08 Sep, 2019
Reviewer #1 agreed
On 05 Sep, 2019
Editor assigned
On 16 Aug, 2019
Reviewers invited
Invitations sent on 16 Aug, 2019
Submission checks complete
On 15 Aug, 2019
Editor invited
On 15 Aug, 2019
First submitted
On 30 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Health Services Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
María Victoria Cuevas
Hospital Universitario de Burgos
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7991-1234
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
No community comments so far
Submission checks complete
On 07 Nov, 2019
Editorial decision: Accept
On 21 Oct, 2019
Editor assigned
On 20 Oct, 2019
Editor invited
On 19 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 18 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 17 Oct, 2019
Editor assigned
On 27 Sep, 2019
Submission checks complete
On 26 Sep, 2019
Editor invited
On 26 Sep, 2019
Version 1
Posted 20 Aug, 2019
No comments provided
Editorial decision: Major revision
On 19 Sep, 2019
Review #2 received
Received 18 Sep, 2019
Review #1 received
Received 15 Sep, 2019
Reviewer #2 agreed
On 08 Sep, 2019
Reviewer #1 agreed
On 05 Sep, 2019
Editor assigned
On 16 Aug, 2019
Reviewers invited
Invitations sent on 16 Aug, 2019
Submission checks complete
On 15 Aug, 2019
Editor invited
On 15 Aug, 2019
First submitted
On 30 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background
We analyze the cost of an incorrect application, by the hematologist, of bridging anticoagulation in patients with low-risk atrial fibrillation (AF) needing interruption of treatment prior to a scheduled invasive procedure. Although not recommended, bridging therapy is widely used, resulting in avoidable costs and increased workload.
Methods
Observational retrospective study. We recorded demographic and clinical data including age, sex, type of procedure, use of bridging therapy with low molecular weight heparin (LMWH), and hemorrhagic complications within 30 days of acenocoumarol withdrawal.
Results
Acenocoumarol was stopped in 161 patients, 97 (60%) were male and 64 (40%) female. Average age was 76,11 ± 8,45 years. Procedures included: minor surgical intervention 58 (36%), colonoscopy 61 (38%), gastroscopy 11 (7%), breast biopsy 4 (2.5%), prostate biopsy 4 (2.5%), infiltration 5 (3%), and other 18 (11%). All patients received bridging anticoagulation with LMWH (40mg enoxaparin per day) 3 days before and 3 days after the procedure (6 doses). We used a total of 966 doses, at €4.5 per unit, resulted in €4,347 of total cost. No complications occurred in 156 patients (97%). Hemorrhage was observed in 5 cases: 1 major hemorrhage needing 6 days of hospital stay and transfusion, and 4 minor hemorrhages (2 patients needed Emergency attendance and 2 required hospital admission for 3 and 2 days, respectively). The cost of Emergency care was €237.36, and the cost of hospital stay was €6860.81 (€623.71 per day, for 11 days). The total cost of the incorrect application of the protocol was €11445.17.
Conclusion
Guidelines about bridging anticoagulation in low risk AF patients undergoing scheduled invasive procedures were not followed. This practice increments the complications and supposes an increase in costs besides to an inadequate use of the human resources.
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