I am wondering how much influence health insurance companies have in the decision whether to hold Coumadin or use bridge therapy. Bridge therapy is much more expensive, by far, than merely holding.
If Heparin is used, it means that the patient has to be admitted a couple of days ahead of time to be hooked up to IV Heparin, Then there is the wait for the INR to get to the right level for the procedure. After the procedure, there are several days of additional hospitalization required for the INR to get back up to therapeutic range, so the patient can go home. This also might involve more than just the gastro doctor, because there might be monitoring by the cardiology team, and there will be additional monitoring by the gastro doctor.
If Lovenox is used at home, it is very expensive, and there are several days worh of shots prior to and post the procedure, and monitoring by a cardiologist, maybe.
Both of these methods will use additional labwork.
Most of the time in regular patients, these procedures are on an outpatient basis, in and out in one day. No additional medical monitoring.
If the patient is told to hold Coumadin and then resume after the procedure, everything is done outside of the hospital, unless the patient is admitted afterwards until they are therapeutic.
So we have the safer way to go which is much more expensive, versus the "dicey" way to go which is cheap and fast.
Is it just possible that the safety of patients is less important than the bottom line?
Is it possible that there is pressure to go the much cheaper route? I don't think many of us would ever know if that were the case, unless of course, we were in the medical or insurance field. These things aren't routinely discussed with the patient.
