Potential clinical efficacy and cost benefit of a transesophageal echocardiography-guided low-molecular-weight heparin (enoxaparin) approach to antithrombotic therapy in patients undergoing immediate cardioversion from atrial fibrillation

An alternative clinical management strategy and cost analysis model is pres ented for patients with atrial fibrillation of >2 days' duration who may be nefit from immediate cardioversion with self-administered low-molecular-wei ght heparin (enoxaparin) as a bridge antithrombotic therapy to warfarin, af ter a negative transesophageal echo-cardiography (TEE) screening for thromb us. Assuming no difference in stroke or bleeding rates, our cost minimizati on model shows that the TEE-guided enoxaparin treatment costs are $1353 low er per patient than an Intravenous unfraction-ated heparin approach. Sensit ivity analyses for stroke and bleeding reveal that the treatment-cost econo mic dominance of the TEE-guided enoxaparin approach may be enhanced by an e xpected improvement in clinical outcome.