fondaparinux and Colonic-Neoplasms

The factor Xa inhibitor, fondaparinux was used for prevention of venous thromboembolism in the clinical setting. We evaluated the antithrombotic effect, complications and economic aspects of this agent in the patients undergoing laparoscopic surgery.. Forty one patients scheduled for laparoscopic abdominal surgery were divided into two groups. In group F (N = 33), patients received once-daily subcutaneous injection of fondaparinux (2.5 mg x day(-1)) for 4 postoperative days. In group E (N = 8), patients did not receive therapy. In group F, general anesthesia with transversus abdominis plane (TAP) block was administered during surgery, and general anesthesia with epidural anesthesia was performed in group E. We evaluated incidence of DVT (deep vein thrombosis), abnormal bleeding, other postoperative complications, and economic benefit to the hospital.. In both groups, no patient developed DVT Abnormal bleeding was observed in 7 patients of group E. Postoperative complications and pain were not different between the two groups. The revenue in group F was 34,434 yen/patient lower than that of group E due to Japanease insulance system.. No patients developed DVT and severe complications of fondaparinux after laparoscopic abdominal cancer surgery. However, revenue to the hospital decreased 34,434 yen/patient by use of analgestic method. We must consider cost-benefit in use of fondaparinux.

Topics: Aged; Aged, 80 and over; Anesthesia, General; Anticoagulants; Colonic Neoplasms; Cost-Benefit Analysis; Economics, Hospital; Factor Xa Inhibitors; Female; Fondaparinux; Health Care Costs; Humans; Laparoscopy; Male; Middle Aged; Polysaccharides; Postoperative Complications; Venous Thromboembolism

To illustrate clinical and management issues in the prevention of venous thromboembolism (VTE) in health systems.. Lack of evidence to guide the choice among available anticoagulants and the dosing, timing of initiation, and duration of therapy for VTE prevention in certain clinical situations can present challenges for clinicians. Patient characteristics such as the presence of obesity, epidural catheters, renal impairment, or heparin- induced thrombocytopenia complicate the decision-making process. The introduction of new anticoagulants may overcome some of the clinical challenges associated with VTE prophylaxis, but determining whether to add new agents to the formulary and restrict their use may pose management challenges. The safety, effectiveness, ease of use, and cost of new agents compared with older agents already on the formulary are primary considerations.. An understanding of the clinical and management issues involved in preventing VTE is needed to improve the use of anticoagulants and reduce the incidence of VTE in health systems.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Bariatric Surgery; Colonic Neoplasms; Dalteparin; Female; Fondaparinux; Heart Failure; Humans; Kidney Diseases; Male; Middle Aged; Obesity; Perioperative Care; Pharmacy Service, Hospital; Polysaccharides; Venous Thromboembolism