We estimated the hospital charges for the patients with hemophilia in eight institutions enlisted in this study, and discussed the characteristic features and points at issue regarding the comprehensive costing system using the Diagnosis Procedure Combination(DPC), when adopted. We calculated the total days of hospital admission and total charges based on the data supplied from the institutions during the period between April 2002 and March 2004. We analyzed various factors such as types of disease, patient’s body weight, the presence or absence of inhibitors and whether or not the patients had been treated surgically.
The total days of hospital admission and the mean hospital charges per day(MHCD) varied among the institutions ranging from 124,110 yen to 220,080 yen, and the MHCD appeared to increase in accordance with the patient’s body weight and the titer of inhibitors as well. Therefore, the comprehensive costing system using DPC would not be beneficial to the institutions, and its adoption appears to be difficult at this stage of investigation.

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Recent clinical trials have shown that HMG-CoA reductase inhibitors (statins) reduce the risk of acute coronary events. These beneficial effects are thought to be due not only to lipid-lowering functions, but also to the direct vascular protective activities including antithrombotic properties. The aim of this study was to elucidate the effects of statins on the blood coagulation and fibrinolytic regulation factors in human endothelial cells, in vitro. Human umbilical vein endothelial cells (HUVEC) were incubated with fluvastatin, a liposoluble statin, at 37°C for 24 hours. After extraction of the total RNA, mRNA’s of tissue factor pathway inhibitor (TFPI), thrombomodulin (TM) and plasminogen activator inhibitor type-1 (PAI-1) were individually analyzed by the real-time PCR. Fluvastatin increased mRNA levels of TFPI and TM in a dose-dependent manner, but reduced the induction of PAI-1 mRNA level. The similar effects were observed in the levels of TFPI, TM and PAI-1 antigens in the mediums and cell lysates. Furthermore, effects of fluvastatin on the expression of TFPI, TM and PAI-1 mRNA’s were suppressed by mevalonate and geranylgeranylpyrophosphate (GGPP) but not by farnesylpyrophosphate (FPP).
Taken together, these results suggest that statins lead to the acquisition of anticoagulation properties in human endothelial cells in vivo.

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