Parenteral anticoagulation with the heparinoid Lomoparan (Org 10172) in patients with heparin induced thrombocytopenia and thrombosis.

Progressive thrombocytopenia may develop in as many as 5% of patients receiving heparin anticoagulation. In these patients, the risk of thromboembolic complications as well as continued thrombocytopenia necessitates discontinuation of heparin and initiation of an alternative anticoagulant when indicated. The heparinoid Lomoparan (Org 10172) is a mixture of several non-heparin low molecular weight glycosaminoglycans with proven anticoagulant efficacy that is generally non-reactive with platelets in the presence of plasma from patients with heparin induced thrombocytopenia, whereas standard heparin will induce platelet aggregation. We evaluated the role of heparinoid as a potential alternative anticoagulant in patients with heparin induced thrombocytopenia. During a 6 month period, we identified six patients with heparin induced thrombocytopenia who required an alternative parenteral anticoagulant, four as primary treatment for specific medical problem, and two as anticoagulation during a necessary surgical procedure. Heparinoid was used successfully in both medical and surgical patients requiring parenteral anticoagulation. In no case was there an exacerbation of the thrombocytopenia nor thromboembolic complications while on heparinoid therapy. Three of our patients sustained hemorrhagic complications, predominantly in the post-surgical setting in association with elevated anti-factor Xa levels and additional anticoagulant agents. We feel that these results confirm the utility of heparinoid anticoagulation in a select subset of patients with heparin induced thrombocytopenia who require continued parenteral anticoagulation.

Improving revenue collection for ambulatory pharmaceutical services.

A method of improving revenue collection for ambulatory pharmaceutical services was studied. Data were collected and compared from two phases. In Phase 1, all charges for outpatient pharmaceutical services were billed by the business office. During Phase 2, a pharmacy-based cash-and-carry policy was initiated; patients were encouraged to pay for their prescriptions by cash, check, or credit card, and third-party agencies were billed directly for prescriptions when patients had such coverage. Samples of 1000 prescriptions were randomly selected in each phase to determine the amount of charges collected. Criteria for inclusion of prescriptions were the same in each phase. For the 831 prescriptions meeting the study criteria in Phase 1, 46% of the total $895,812 in charges was collected. For the 767 prescriptions meeting the same criteria in Phase 2, 85% of the total $892,185 charges was collected. It required an additional 1.5 minutes for the pharmacy to process a prescription in Phase 2. Patients receiving emergency medical services and those covered by Medicare had the poorest collection rates. The highest rates occurred for patients covered by Medicaid and those receiving maintenance medication. The cash-and-carry policy notably improved revenue collection and the efficiency of the collection process for outpatient pharmaceutical services.