On 2016 May 04, David Keller commented:

Would the use of fondaparinux instead of LMWH reduce residual risk of HIT (and costs) even more?

This study demonstrates an impressive reduction in the risk of heparin-induced thrombocytopenia (HIT), and associated costs, by the use of low-molecular-weight heparin (LMWH) instead of unfractionated heparin (UFH) whenever possible. While LMWH has a much lower risk of causing HIT than does UFH, the use of fondaparinux (Arixtra) has an even lower risk of causing HIT (although fondaparinux-induced HIT cases have been reported). How much of the residual risk of HIT could be decreased by the use of fondaparinux, when appropriate, instead of LMWH? Would overall costs of care decrease thereby, or would the higher cost of branded fondaparinux compared with generic LMWH dominate the cost-benefit analysis, at least until generic fondaparinux becomes available?

On 2016 May 04, David Keller commented:

This important study should end "automatic" substitution of UFH for LMWH merely to save money

It has been known for years that the use of low-molecular-weight heparin (LMWH) causes a lower risk of the feared condition heparin-induced thrombocytopenia (HIT) than does the use of unfractionated heparin (UFH). The first generic LMWH was approved by the FDA in 2010, but the cost of UFH remains lower still. Some skilled nursing facility (SNF) pharmacists have been allowed the cost-saving practice of "automatically" substituting subcutaneous (SC) UFH for the SC LMWH ordered by admitting physicians. This important paper demonstrates that the overall cost of using UFH is higher than that of using LMWH. Because SNFs are only subjected to the immediate costs of buying the heparin and administrating it, while the overall costs (including re-hospitalization for HIT) are borne by society and the patient, regulatory agencies should end the substitution of UFH for physician-ordered LMWH by SNF pharmacists. The cost savings of UFH are illusory.

On 2016 May 04, David Keller commented:

This important study should end "automatic" substitution of UFH for LMWH merely to save money

It has been known for years that the use of low-molecular-weight heparin (LMWH) causes a lower risk of the feared condition heparin-induced thrombocytopenia (HIT) than does the use of unfractionated heparin (UFH). The first generic LMWH was approved by the FDA in 2010, but the cost of UFH remains lower still. Some skilled nursing facility (SNF) pharmacists have been allowed the cost-saving practice of "automatically" substituting subcutaneous (SC) UFH for the SC LMWH ordered by admitting physicians. This important paper demonstrates that the overall cost of using UFH is higher than that of using LMWH. Because SNFs are only subjected to the immediate costs of buying the heparin and administrating it, while the overall costs (including re-hospitalization for HIT) are borne by society and the patient, regulatory agencies should end the substitution of UFH for physician-ordered LMWH by SNF pharmacists. The cost savings of UFH are illusory.

On 2016 May 04, David Keller commented:

Would the use of fondaparinux instead of LMWH reduce residual risk of HIT (and costs) even more?

This study demonstrates an impressive reduction in the risk of heparin-induced thrombocytopenia (HIT), and associated costs, by the use of low-molecular-weight heparin (LMWH) instead of unfractionated heparin (UFH) whenever possible. While LMWH has a much lower risk of causing HIT than does UFH, the use of fondaparinux (Arixtra) has an even lower risk of causing HIT (although fondaparinux-induced HIT cases have been reported). How much of the residual risk of HIT could be decreased by the use of fondaparinux, when appropriate, instead of LMWH? Would overall costs of care decrease thereby, or would the higher cost of branded fondaparinux compared with generic LMWH dominate the cost-benefit analysis, at least until generic fondaparinux becomes available?