La tromboprofilassi post-chirurgica e la terapia del tromboembolismo venoso con eparine a basso peso molecolare: ruolo della bemiparina in una strategia di minimizzazione dei costi

Abstract

The introduction of low molecular weight heparins (LMWHs) has opened new possibilities for the costeffective management of the thrombotic risk associated with surgical procedures, allowing prophylaxis – and sometimes even treatment of established deep vein thrombosis – on a out-patient basis. This article gives a brief overview of the pharmacological and clinical features of LMWHs, focusing on the differences with unfractionated heparin (UFH), which allow great simplification of dosing regimens and settings without disadvantages in terms of efficacy or safety. In fact, some data indicate that LMWH might be better tolerated than UFH. The overcoming of the need for hospitalization for pre- and post-surgical thromboprophylaxis has important economical implications and is leading to a different formation of health care costs in these patients. The clinical and economical consequences of the pharmacological differences between LMWHs and UFH are analyzed with a “value matrix”, a pharmacoeconomical technique for preliminary evaluations. The last section examines Italian drug acquisition costs and compares the economical values of the recommended dosing regimens of LMWHs available on the national market for the prevention and the treatment of deep vein thrombosis. Bemiparin is the most convenient LMWH for all approved indications. In the management of surgery-associated thrombotic risk, no clinically relevant differences among LMWHs have been demonstrated. Thus, bemiparin appears to be the most logical choice in a costminimization strategy.