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When visualized left atrial thrombus was used as the only indication for anticoagulation,transesophageal echocardiography performed only in patients with a history of cardiac problems cost$9000 per quality-adjusted life-year;transesophageal echocardiography in all patients cost$13,000 per quality-adjusted life-year.Cost savings and decreased morbidity and mortality rates associated with reduction in preventable recurrent strokes substantially offset examination costs and risks of anticoagulation.These results were moderately sensitive to efficacy of anticoagulation and incidence of intracranial bleeding during anticoagulation and were mildly sensitive to prevalence of left atrial thrombus,rate of recurrent stroke in patients with thrombus,quality of life after stroke,cost of transesophageal cardiography,and specificity of transesophageal echocardiography.Transthoracic echocardiography,alone or in sequence with transesophageal echocardiography,was not cost-effective compared with transesophageal echocardiography.Physicians should consider doing transesophageal echocardiography in all patients with new-onset stroke. |
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cerebral embolism
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cerebrovascular accident
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echocardiogram
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prevention of neurologic disorders
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