Abstract

Anticoagulants represent a class of drugs that havehigh potential for adverse patient outcomes. Warfarin and unfractionated heparin (UFH), in particular, are rec-ognized as frequent drug-related causes of adverse events in hospitalized patients.1-3 The repeated laboratory moni-toring and dosage adjustments that are required, plus the difficulty of such procedures, further compound the prob-lems associated with these drugs. Low-molecular-weight heparins (LMWHs) offer advantages over warfarin and UFH because these drugs have a more predictable dose– response relationship and do not require routine laboratory monitoring of anticoagulation parameters. Further, LMWHs may be more efficacious and have improved safety and convenience in certain situations.4 However, a disadvantage of the use of LMWHs com-pared with warfarin or UFH is cost. The acquisition cost of LMWHs greatly exceeds that of other anticoagulants. Some have argued that the monitoring associated with warfarin or UFH results in higher overall costs of care compared with that of LMWHs.5,6 Nevertheless, some hospitals have at-tempted to limit the use of LMWHs. These efforts are often met with resistance from clinicians because of the perceived efficacy advantages of some LMWHs in certain indications.7 Further complicating this situation is the current debate over the clinical equivalence of different LMWH product