ABSTRACT
BACKGROUND: Patients with atrial fibrillation (AF) make a unique group of strokes. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are among the medications used for preventing blood coagulation. This study was carried out aiming at analyzing the cost effectiveness of LMWH versus UFH in hospitalized patients with stroke due to AF with respect to the Iranian population. METHODS: This randomized study was an economic evaluation of cost effectiveness with the help of the cross-sectional data of 2013-2015. In this study, 74 patients had undergone treatment in two groups, before being evaluated. Half of the patients were treated by LMWH, while the other half was treated by UFH. Effectiveness criterion was prevention of new stroke recurrence. RESULTS: Average medical direct costs, non-medical direct costs, and indirect costs of UFH were 110375 ± 40411$, 15594 ± 11511$, and 21723 ± 19933$, respectively. Same average medical direct costs, non-medical direct costs, and indirect costs of LMWH were 99573 ± 59143$, 9016 ± 17156$, and 10385 ± 10598$, respectively. The number of prevention of new strokes due to AF in LMWH and UFH was 2 and 0, respectively. Expected effectiveness in LMWH and UFH groups was 0.56 and 0.51, respectively. Moreover, the expected costs were 26737.61$ and 30776.18$, respectively. The incremental cost-effectiveness ratio for stroke due to AF was -150, 201, 26$ per prevention of stroke recurrence (p-values ≤ 0/05). CONCLUSION: The results of the cost-effectiveness analysis of LMWH versus UFH showed that LMWH is a dominant strategy for patients with stroke due to AF in Iranian population.
ABSTRACT
BACKGROUND: Anticoagulation with adjusted dose warfarin is a well-accepted treatment for the prevention of recurrent stroke in patients with atrial fibrillation. Meanwhile, using bridging therapy with heparin or heparinoids before warfarin for initiation of anticoagulation is a matter of debate. We compared safety, efficacy, and tolerability of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) as a bridging method in patients with recent ischemic stroke due to atrial fibrillation. METHOD: This study was a randomized single-blind controlled trial in patients with acute ischemic stroke due to atrial fibrillation who were eligible for receiving warfarin and were randomly treated with 60 milligrams (mg) of LMWH (enoxaparin) subcutaneously every 12 h, or 1000 units/h of continuous intravenous heparin. The primary efficacy endpoints were recurrence of new ischemic stroke, myocardial infarction and/or death. The primary safety endpoint was central nervous system and/or systemic bleeding. RESULTS: Seventy-four subjects were recruited. Baseline demographic and clinical characteristics of two groups were matched. Composite endpoint outcome of new ischemic stroke, myocardial infarction, and/or death in follow-up period was seen in 10 subjects (27.03%) in UFH group and in four subjects (10.81%) in LMWH group (p value: 0.136). All hemorrhages and symptomatic central nervous system (CNS) hemorrhages in follow-up period were in 7 (18.9%) and 4 (10.8%) patients in UFH group, in 5 (13.5%), and 3 (8.1%) patients in LMWH group (p values: 0.754 and 0.751), respectively. Drop out and major adverse-effects such as heparin-induced thrombocytopenia and drug hypersensitivity were not seen in any patient. CONCLUSION: Enoxaparin can be a safe and efficient alternative for UFH as bridging therapy.
