Thromboprophylaxis with low-molecular-weight heparin: economic considerations

Postoperative thromboembolic events are a major cost factor for every healthcare system. Although thromboprophylaxis carries its own costs, the application of a thromboprophylactic regimen is cost-effective in most instances, at least in high-risk patients. A regimen of general postoperative prevention of deep vein thrombosis is always more cost-effective than surveillance programmes with treatment after diagnosis, and is almost always more cost-effective than no prophylaxis. For patients with a high risk of postoperative thromboembolism, such as after orthopaedic surgery, low-molecular-weight heparins have a rather clear advantage over prophylaxis with unfractionated heparin and warfarin, also in terms of cost- effectiveness. With regard to moderate-risk patients, such as after general surgery, the economic benefits are less clear. However, since the results of economic analyses are heavily dependent on the healthcare system, and since there are methodological difficulties and uncertainties connected with the analyses, the implications are difficult -- if not impossible -- to generalize. There is an urgent need for further prospective studies, which should be performed with defined economic variables a priori and in close cooperation with health economists

Kirurgi snart även primärprevention vid slaganfall av höggradig karotisstenos

Indications for and the results of carotid endarterectomy in symptomatic and asymptomatic carotid artery stenosis are reviewed. The main indication for carotid endarterectomy is symptomatic stenosis of a carotid artery with >70 percent lumen reduction according to the NASCET method, or >85 percent lumen reduction according to the ECST method. The operation should ideally be performed within two weeks after the onset of symptoms. Preliminary results from the ACST study, indicating significant beneficial effects of carotid endarterectomy also in asymptomatic carotid artery stenosis have been orally presented. Assessment of and surgery upon Swedish patients with significant carotid artery stenosis should be performed in specialised multidisciplinary »carotid artery centers«. Endovascular treatment of carotid artery stenosis should at the present stage only be performed within clinical trials