Cost-effectiveness of self-managed anticoagulant therapy in Germany.

In this study, the cost-effectiveness of anticoagulation self-management--which is now established in Germany--was compared with the conventional method of monitoring oral anticoagulant therapy by the patient's family physician or by a specialist. Costs were determined based on the usual conditions in Germany such as frequency of testing and control testing, scope of the tests, and diagnostic and therapeutic standards for thromboembolic or bleeding complications. In addition to direct monitoring costs, we determined the costs for treating minor and serious complications and used them to calculate overall therapy costs. The incidence of complications was estimated based on the results of more recent studies. The only costs considered in this study were those covered by the primary cost carrier--the government-controlled health insurance funds--and included outpatient visits and, in cases of serious complications, acute inpatient treatment and rehabilitation. It was shown that the costs to treat minor complications only slightly affected annual, overall treatment costs. The potential reduction in incidences of serious bleeding and thromboembolic complications due to anticoagulation self-management--which is independent of the indication for oral anticoagulation--reduced overall therapy costs from DM 2,061.48/patient-year for conventional therapeutic methods to DM 1,342.46/patient-year for patients under self-management of anticoagulation.

[Reliable Quick value management by self determination]. / Sicheres Quickwert-Management durch Selbstbestimmung.

Because of the considerably increased risk of thrombembolic complications after implantation of mechanical heart valves, lifelong anticoagulation is required. In the face of frequently unsteady prothrombin-time (PT)-values, a stable anticoagulation is one of the most difficult tasks in attending patients with heart-valve-prosthesis. If PT is out of the therapeutic range, the risk of bleeding or of thrombembolism increases disproportionately. Two differently trained groups of phenprocoumon-treated patients monitored their PT themselves for 6 months by means of a coagulometer, and they also determined their weekly dose of phenprocoumon. PTs were therapeutic 80.5% resp. 93.8% of the time. Intensive training and care maximized safety of anticoagulation.

Left ventricular after load as a result of levocardiography with contrast media of various osmolality.

Contrast media have been successfully used as a diagnostic aid in radiology for decades. It has, however, been necessary to accept certain, in some cases unexplained, undesirable side effects because of their physicochemical properties. The conventional preparations available have for more than 40 years been iodinated salts or acids, whose major disadvantage has been high osmolality. For some years now, a new generation of contrast media has been available. These contrast media exhibit a far lower osmolality due to the lack of ionicity. As a result of the volume load of the left ventricle by levocardiography, there is usually an increase of the left ventricular end-diastolic pressure in the pathologic range over 12 mmHg. We were able to prove this in 120 consecutive patients whom we examined. The pressure increase with the use of nonionic contrast media was considerably lower. The differentiated observation of various risk groups showed no signs of valid predictive parameters.