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Balancing the clinical outcomes and economics associated with thromboembolic prophylaxis.

The approach to the treatment of patients is being influenced by the movement towards integrating health care services. This trend presents several challenges to health care professionals as patients move through the cycles of wellness, prevention, acute treatment, and after-care. Consequently, the development of treatment guidelines based upon clinical and economic parameters is critical. Preventing thromboembolic complications is receiving a great deal of attention due to the tremendous medical and economic consequences of deep venous thrombosis and pulmonary embolism. The early discharge of patients from acute surgical and medical facilities is increasing the need to consider outpatient prophylaxis. Pharmacoeconomic modeling demonstrates that enoxaparin may be more cost-effective than warfarin for outpatient prophylaxis when used for 3 weeks or less. The requirement of a subcutaneous injection of enoxaparin is not a detraction to this recommendation. Patient self-medication is a common practice and is growing in prevalence. Patients are eager to learn about their illnesses and treatment options as a result of their attitudes regarding empowerment and responsibility for their own health care.