User login
Deep venous thrombosis and pulmonary emboli are, unfortunately, common conditions for which we admit patients to the hospital. While sometimes, the emergency room is able to discharge low-risk patients on Coumadin (warfarin), along with an injectable agent to bridge them until their INR becomes therapeutic, these patients are often best served being admitted, or at the very least, observed.
Yet, in 2012 with the strict guidelines patients must attain to even meet admission criteria, it is imperative that we treat our patients as effectively as possibly, while ensuring their safety and comfort. If they only meet criteria for observation status, we also must be particularly mindful of how much their hospital care will affect their wallets.
And surely, I am not alone in spending large chunks of time contacting patients’ pharmacists and waiting on hold for what can seem to be an eternity in the midst of a hectic day, only to find out that their copay for the injectable agent is several hundreds of dollars, which they cannot afford, so they cannot be safely discharged home since they cannot continue treatment at home.
It’s probably obvious that I am no fan of warfarin. All the sweet little old ladies and gentlemen who are admitted with potentially life-threatening gastrointestinal hemorrhages, severe hematuria, or other sources of blood loss simply because they were put on a medication that made their INR shoot up can be really disheartening. But if the options are warfarin or the potentially lethal complications it is meant to prevent, naturally, we prescribe it without hesitation.
Needless to say, I was thrilled a few weeks ago when the Food and Drug Administration approved a drug for oral treatment of DVT/PE. Rivaroxaban is a well-established drug used for atrial fibrillation. Now it has an indication to treat deep venous thrombosis and pulmonary emboli. It can be used for nonvalvular atrial fibrillation, treatment and secondary prophylaxis of both DVT and pulmonary embolism, and even postop DVT prophylaxis after hip repair or arthroplasty of the knee. And since it is not a newbie in the market, many insurance companies already cover it with a reasonable copay.
I, for one, remain elated at the implications of having a pill that will allow me to treat my patients effectively in the comfort of their own home, with no painful injections or regular visits to the lab to get their INR checked, and I know our patients will love having this option as well.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.
Deep venous thrombosis and pulmonary emboli are, unfortunately, common conditions for which we admit patients to the hospital. While sometimes, the emergency room is able to discharge low-risk patients on Coumadin (warfarin), along with an injectable agent to bridge them until their INR becomes therapeutic, these patients are often best served being admitted, or at the very least, observed.
Yet, in 2012 with the strict guidelines patients must attain to even meet admission criteria, it is imperative that we treat our patients as effectively as possibly, while ensuring their safety and comfort. If they only meet criteria for observation status, we also must be particularly mindful of how much their hospital care will affect their wallets.
And surely, I am not alone in spending large chunks of time contacting patients’ pharmacists and waiting on hold for what can seem to be an eternity in the midst of a hectic day, only to find out that their copay for the injectable agent is several hundreds of dollars, which they cannot afford, so they cannot be safely discharged home since they cannot continue treatment at home.
It’s probably obvious that I am no fan of warfarin. All the sweet little old ladies and gentlemen who are admitted with potentially life-threatening gastrointestinal hemorrhages, severe hematuria, or other sources of blood loss simply because they were put on a medication that made their INR shoot up can be really disheartening. But if the options are warfarin or the potentially lethal complications it is meant to prevent, naturally, we prescribe it without hesitation.
Needless to say, I was thrilled a few weeks ago when the Food and Drug Administration approved a drug for oral treatment of DVT/PE. Rivaroxaban is a well-established drug used for atrial fibrillation. Now it has an indication to treat deep venous thrombosis and pulmonary emboli. It can be used for nonvalvular atrial fibrillation, treatment and secondary prophylaxis of both DVT and pulmonary embolism, and even postop DVT prophylaxis after hip repair or arthroplasty of the knee. And since it is not a newbie in the market, many insurance companies already cover it with a reasonable copay.
I, for one, remain elated at the implications of having a pill that will allow me to treat my patients effectively in the comfort of their own home, with no painful injections or regular visits to the lab to get their INR checked, and I know our patients will love having this option as well.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.
Deep venous thrombosis and pulmonary emboli are, unfortunately, common conditions for which we admit patients to the hospital. While sometimes, the emergency room is able to discharge low-risk patients on Coumadin (warfarin), along with an injectable agent to bridge them until their INR becomes therapeutic, these patients are often best served being admitted, or at the very least, observed.
Yet, in 2012 with the strict guidelines patients must attain to even meet admission criteria, it is imperative that we treat our patients as effectively as possibly, while ensuring their safety and comfort. If they only meet criteria for observation status, we also must be particularly mindful of how much their hospital care will affect their wallets.
And surely, I am not alone in spending large chunks of time contacting patients’ pharmacists and waiting on hold for what can seem to be an eternity in the midst of a hectic day, only to find out that their copay for the injectable agent is several hundreds of dollars, which they cannot afford, so they cannot be safely discharged home since they cannot continue treatment at home.
It’s probably obvious that I am no fan of warfarin. All the sweet little old ladies and gentlemen who are admitted with potentially life-threatening gastrointestinal hemorrhages, severe hematuria, or other sources of blood loss simply because they were put on a medication that made their INR shoot up can be really disheartening. But if the options are warfarin or the potentially lethal complications it is meant to prevent, naturally, we prescribe it without hesitation.
Needless to say, I was thrilled a few weeks ago when the Food and Drug Administration approved a drug for oral treatment of DVT/PE. Rivaroxaban is a well-established drug used for atrial fibrillation. Now it has an indication to treat deep venous thrombosis and pulmonary emboli. It can be used for nonvalvular atrial fibrillation, treatment and secondary prophylaxis of both DVT and pulmonary embolism, and even postop DVT prophylaxis after hip repair or arthroplasty of the knee. And since it is not a newbie in the market, many insurance companies already cover it with a reasonable copay.
I, for one, remain elated at the implications of having a pill that will allow me to treat my patients effectively in the comfort of their own home, with no painful injections or regular visits to the lab to get their INR checked, and I know our patients will love having this option as well.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.
