Delivering Integrated Care and Cost Management
The IHTC works collaboratively with payors to optimize care. We ensure that the patients and families we serve have access to care and therapies, thereby helping to contain costs and reduce both bleeding events and utilization of resources.
The IHTC Pharmacy’s ability to purchase clotting factor through the Public Health Service 340B discount program and our overall pricing structure benefit payors and patients by dispensing clotting factor at significantly reduced prices.
- Individuals with multiple risk factors or triggers for thrombosis, such as resistance to activated protein C and an acquired condition, or two inherited thrombophilic disorders are at increased risk of thrombosis compared to singularly affected individuals and warrant special consideration. It is therefore reasonable to perform a complete evaluation on patients who present with their first or recurrent episodes of thromboembolic disease, especially those who present in childhood.
- APC resistance leads to a dramatically increased risk of thrombosis associated with pregnancy or estrogen-containing oral contraceptives. Because of the high frequency of APC resistance in the general population, the frequency of homozygous deficient patients may be 1:5,000.
- Warfarin (Coumadin®) should not be used during pregnancy due to its teratogenic effect.
- Before becoming pregnant, any woman with antiphospholipid syndrome considering pregnancy is advised to consult a provider who specializes in high-risk pregnancies and to consult a hematologist with knowledge in coagulation. Patients with a history of recurrent spontaneous abortions may be placed on intravenous (IV) or subcutaneous heparin and/or oral aspirin during that time that conception is attempted or during pregnancy to prevent miscarriage due to clotting of the placental blood vessels.
- In patients with heparin-induced thrombocytopenia (HIT), the platelet count should begin to recover in 2 to 5 days once all heparin is discontinued. Despite the discontinuation of the heparin, however, the patient is at continued high risk of HIT-related thrombosis for the next 30 days, and alternate anticoagulation is often required, depending on the patient’s clinical circumstances. Use of oral anticoagulation with Coumadin® alone is contraindicated in this entity due to the high risk for development of warfarin-induced skin necrosis and venous limb gangrene.