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Anticoagulation Management in the Emergency Department

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Anticoagulation Management

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Abstract

The emergency department is a unique care setting where patients often present with urgent and sometimes life-threatening conditions. Pharmacists in the emergency department are uniquely situated to help providers care for patients by obtaining medication histories upon arrival, identifying adverse drug reactions and recommending treatment options, facilitating the selection of outpatient regimens, counseling patients for discharge on new drug therapies, and facilitating follow-up when transitioning to outpatient management.

This chapter will focus on the pharmacist role in the management of anticoagulant therapy and how it relates to common scenarios such as venous thromboembolism treatment, adverse bleeding events, and response to stroke in the emergency department.

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References

  1. Institute of Medicine of the National Academies Committee on the Future of Emergency Care in the United States Health System (2006) Historical development of hospital-based emergency and trauma care. In: Hospital-based emergency care: at the breaking point. National Academy Press, Washington, DC, pp 353–364

    Google Scholar 

  2. Berry NS, Folstad JE, Bauman JL et al (1992) Follow-up observations on 24-hour pharmacotherapy services in the emergency department. Ann Pharmacother 26(4):476–480

    CAS  PubMed  Google Scholar 

  3. Culbertson V, Anderson RJ (1981) Pharmacist involvement in emergency room services. Contemp Pharm Pract 4(3):167–176

    CAS  PubMed  Google Scholar 

  4. Elenbaas RM, Waeckerle JF, McNabney WK (1977) The clinical pharmacist in emergency medicine. Am J Hosp Pharm 34(8):843–846

    CAS  PubMed  Google Scholar 

  5. High JL, Gill AW, Silvernale DJ (1981) Clinical pharmacy in an emergency medicine setting. Contemp Pharm Pract 4(4):227–230

    CAS  PubMed  Google Scholar 

  6. Laivenieks N, McCaul K, O’Brodovich M (1992) Clinical pharmacy services provided to an emergency department. Can J Hosp Pharm 45(3):113–115

    CAS  PubMed  Google Scholar 

  7. Powell MF, Solomon DK, McEachen RA (1985) Twenty-four hour emergency pharmaceutical services. Hosp Pharm 42(4):831–835

    CAS  Google Scholar 

  8. Spigiel RW, Anderson RJ (1979) Comprehensive pharmaceutical services in the emergency room. Am J Hosp Pharm 36(1):52–56

    CAS  PubMed  Google Scholar 

  9. Cesarz JL, Steffenhagen AL, Svenson J et al (2013) Emergency department discharge prescription interventions by emergency medicine pharmacists. Ann Emerg Med 61(2):209–214

    Article  PubMed Central  PubMed  Google Scholar 

  10. Fairbanks RJ, Hildebrand JM, Kolstee KE et al (2007) Medical and nursing staff highly value clinical pharmacists in the emergency department. Emerg Med J 24(10):716–718

    Article  PubMed Central  PubMed  Google Scholar 

  11. Coralic Z, Kanzaria HK, Bero L et al (2014) Staff perceptions of an on-site clinical pharmacist program in an academic emergency department after one year. West J Emerg Med 15(2):205–210

    Article  PubMed Central  PubMed  Google Scholar 

  12. Jacknin G, Nakamura T, Smally AJ et al (2014) Using pharmacists to optimize patient outcomes and costs in the ED. Am J Emerg Med 32(6):673–677

    Article  PubMed  Google Scholar 

  13. Cohen V, Jellinek SP, Hatch A et al (2009) Effect of clinical pharmacists on care in the emergency department: a systematic review. Am J Health Syst Pharm 66:1353–1361

    Article  PubMed  Google Scholar 

  14. Hampton J (2011) Rapid-sequence intubation and the role of the emergency pharmacist. Am J Health Syst Pharm 68:1320–1330

    Article  PubMed  Google Scholar 

  15. Amini A, Faucett EA, Watt JM et al (2013) Effect of a pharmacist on timing of postintubation sedative and analgesic use in trauma resuscitations. Am J Health Syst Pharm 70(17):1513–1517

    Article  PubMed  Google Scholar 

  16. Weant KA, Baker SN (2013) Emergency medicine pharmacists and sepsis management. J Pharm Pract 26(4):401–405

    Article  PubMed  Google Scholar 

  17. Acquisto NM, Hays DP, Fairbanks RJ et al (2012) The outcomes of emergency pharmacist participation during acute myocardial infarction. J Emerg Med 42(4):371–378

    Article  PubMed Central  PubMed  Google Scholar 

  18. Groth ME, McMillian WD, Wolfson DL (2015) Pharmacist input into statewide treatment protocols for emergency medical services. Am J Health Syst Pharm 72(1):61–63

    Article  PubMed  Google Scholar 

  19. Rozich JD, Howard RJ, Justeson JM et al (2004) Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf 30(1):5–14

    PubMed  Google Scholar 

  20. Rozich JD (2001) Medication safety: one organization’s approach to the challenge. J Clin Outcomes Manag 8(10):27–34

    Google Scholar 

  21. The Joint Commission (2011) Comprehensive accreditation manual for hospitals: the official handbook. http://www.jointcommission.org/accreditation/hospitals. Accessed: 12 Mar 2015

  22. Ajdukovic M, Crook M, Angley C et al (2007) Pharmacist elicited medication histories in the emergency department: identifying patient groups at risk of medication misadventure. Pharm Pract 5:162–168

    Google Scholar 

  23. Carter MK, Allin DM, Scott LA et al (2006) Pharmacist-acquired medication histories in a university hospital emergency department. Am J Health Syst Pharm 63:2500–2503

    Article  PubMed  Google Scholar 

  24. Reeder TA, Mutnick A (2008) Pharmacist versus physician-obtained medication histories. Am J Health Syst Pharm 65:857–860

    Article  PubMed  Google Scholar 

  25. Nester TM, Hale LS (2002) Effectiveness of a pharmacist-acquired medication history in promoting patient safety. Am J Health Syst Pharm 59:2221–2225

    PubMed  Google Scholar 

  26. Kramer JS, Stewart MR, Fogg SM et al (2014) A quantitative evaluation of medication histories and reconciliation by discipline. Hosp Pharm 49(9):826–838

    Article  PubMed Central  PubMed  Google Scholar 

  27. Patanwala AE (2014) Emergency pharmacy practice and medication reconciliation. Am J Health Syst Pharm 71:2167–2168

    Article  PubMed  Google Scholar 

  28. Roulet L, Ballereau F, Hardouin JB et al (2014) Adverse drug event non-recognition in emergency departments: an exploratory study on factors related to patients and drugs. J Emerg Med 46(6):857–864

    Google Scholar 

  29. Roulet L, Asseray N, Dary M et al (2012) Implementing a clinical pharmacy survey of adverse drug events in a French emergency department. Int J Clin Pharm 34(6):902–910

    Article  CAS  PubMed  Google Scholar 

  30. Sin B, Yee L, Caludio-Saez M et al (2015) Implementation of a 24-hour pharmacy service with prospective medication review in the emergency department. Hosp Pharm 50(2):134–138

    Article  PubMed  Google Scholar 

  31. Aujesky D, Roy PM, Verschuren F et al (2011) Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomized, non-inferiority trial. Lancet 378(9785):41–48

    Article  PubMed  Google Scholar 

  32. Piran S, Le Gal G, Wells P et al (2013) Outpatient treatment of symptomatic pulmonary embolism: a systematic review and meta-analysis. Thromb Res 132:515–519

    Article  CAS  PubMed  Google Scholar 

  33. Zondag W, den Exter PL, Crobach MJ et al (2013) Comparison of two methods for selection of out of hospital treatment in patients with acute pulmonary embolism. Thromb Haemost 109(1):47–52

    Article  CAS  PubMed  Google Scholar 

  34. Erkens PM, Gandara E, Wells PS et al (2012) Does the pulmonary embolism severity index accurately identify low risk patients eligible for outpatient treatment? Thromb Res 129(6):710–714

    Article  CAS  PubMed  Google Scholar 

  35. Aujesky D, Perrier A, Roy PM et al (2007) Validation of a clinical prognostic model to identify low-risk patients with pulmonary embolism. J Intern Med 261:597–604

    Article  CAS  PubMed  Google Scholar 

  36. Aujesky D, Roy PM, Le Manach CP et al (2006) Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J 27:476–481

    Article  PubMed  Google Scholar 

  37. Kearon C, Akl EA, Comerota AJ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed. American college of chest physicians evidence based clinical practice guidelines. Chest 141:e419s–e494s

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Ageno W, Gallus AS, Wittkowsky A et al (2012) Oral anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed. American college of chest physicians evidence based clinical practice guidelines. Chest 141:e44s–e88s

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Holbrook A, Schulman S, Witt DM et al (2012) Evidence based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed. American college of chest physicians evidence based clinical practice guidelines. Chest 141:e152s–e184s

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  40. Kaganksy N, Knobler H, Rimon E et al (2004) Safety of anticoagulation therapy in well-informed older adults. Arch Intern Med 164:2044–2050

    Article  Google Scholar 

  41. Tang E, Lai C, Lee K et al (2003) Relationship between patients’ warfarin knowledge and anticoagulation control. Ann Pharmacother 37:34–39

    Article  PubMed  Google Scholar 

  42. Moore SJ, Blair EA, Steeb DR et al (2015) Impact of video technology on efficiency of pharmacist-provided anticoagulation counseling and patient comprehension. Ann Pharmacother 49(6):631–638

    Article  PubMed  Google Scholar 

  43. Zed PJ, Filiatrault L (2008) Clinical outcomes and patient satisfaction of a pharmacist-managed emergency department-based outpatient treatment program for venous thromboembolic disease. CJEM 10(1):10–17

    PubMed  Google Scholar 

  44. Schulman S, Kearon C, on behalf of the subcommittee on control of anticoagulation of the Scientific and Standardization committee of the International Society on Thrombosis and Haemostasis (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. Scientific and Standardization Committee Communication. J Thromb Haemost 3:692–694

    Article  CAS  PubMed  Google Scholar 

  45. Arnold DM, Donahoe L, Clarke FJ et al (2007) Bleeding during critical illness: a prospective cohort study using a new measurement tool. Clin Invest Med 30(2):E93–E102

    PubMed  Google Scholar 

  46. Crowther MA, Warkentin TE (2008) Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood 111:4871–4879

    Article  CAS  PubMed  Google Scholar 

  47. Kalus JS (2013) Pharmacologic interventions for reversing the effect of oral anticoagulants. Am J Health System Pharm 70(suppl 1):S12–S21

    Article  CAS  Google Scholar 

  48. Zareh M, Davis A, Henderson S (2011) Reversal of warfarin-induced hemorrhage in the emergency department. West J Emerg Med 12(4):386–392

    Article  PubMed Central  PubMed  Google Scholar 

  49. Palareti G, Leali N, Coccheri S et al (1996) Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian study on complications of oral anticoagulant therapy. Lancet 348:423–428

    Article  CAS  PubMed  Google Scholar 

  50. Rubboli A, Becattini C, Verheugt F (2011) Incidence, clinical impact and risk of bleeding during oral anticoagulation therapy. World J Cardiol 3(11):351–358

    Article  PubMed Central  PubMed  Google Scholar 

  51. Palareti G, Cosmi B (2009) Bleeding with anticoagulation therapy-who is at risk, and how to best identify such patients. Thromb Haemost 102:268–278

    CAS  PubMed  Google Scholar 

  52. Heidbuchel H, Verhamme P, Alings A et al (2013) European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 15:625–651

    Article  PubMed  Google Scholar 

  53. van Ryn J, Stangier J, Haertter S et al (2010) Dabigatran etexilate—a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 103:1116–1127

    Article  PubMed  Google Scholar 

  54. Harenberg J, Giese C, Marx S et al (2012) Determination of dabigatran in human plasma samples. Semin Thromb Hemost 38(1):16–22

    Article  CAS  PubMed  Google Scholar 

  55. Antovic JP, Skeppholm M, Eintrei J et al (2013) Evaluation of coagulation assays versus LC-MS/MS for determinations of dabigatran concentrations in plasma. Eur J Clin Pharmacol 69(11):1875–1881

    Article  CAS  PubMed  Google Scholar 

  56. Helin TA, Pakkanen A, Lassila R et al (2013) Laboratory assessment of novel oral anticoagulants: method suitability and variability between coagulation laboratories. Clin Chem 59(5):807–814

    Article  CAS  PubMed  Google Scholar 

  57. Cuker A, Siegal DM, Crowther MA et al (2014) Laboratory measurement of the anticoagulant activity of the non-vitamin K oral anticoagulants. J Am Coll Cardiol 64(11):1128–1139

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  58. Dale BJ, Ginsberg JS, Johnston M et al (2014) Comparison of the effects of apixaban and rivaroxaban on prothrombin and activated partial thromboplastin times using various reagents. J Thromb Haemost 12(11):1810–1815

    Article  CAS  PubMed  Google Scholar 

  59. Cuker A, Husseinzadeh H (2015) Laboratory measurement of the anticoagulant activity of edoxaban: a systematic review. J Thromb Thrombolysis 39(3):288–294

    Article  CAS  PubMed  Google Scholar 

  60. Fonarow GC, Zhao X, Smith EE et al (2014) Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA 311(16):1632–1640

    Article  PubMed  Google Scholar 

  61. Lansberg MG, O’Donnell MJ, Khatri P et al (2012) Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic therapy and prevention of thrombosis, 9th ed. American college of chest physicians evidence-based clinical practice guidelines. Chest 141:e601s–e636s

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  62. Jauch EC, Saver JL, Adams HP et al (2013) Guidelines for the early management of patients with acute ischemic stroke. Stroke 44:870–947

    Article  PubMed  Google Scholar 

  63. Product Information: Activase(R) intravenous injection, alteplase intravenous injection (2015) Genentech, Inc.(per Manufacturer), South San Francisco

    Google Scholar 

  64. Hacke W, Kaste M, Bluhmki E et al (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Critical Care, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA

    Melissa E. Heim PharmD

  2. Emergency Medicine, University of Wisconsin Hospital and Clinics, 600 Highland Ave., Madison, WI, 53792, USA

    Nathan Sippel PharmD, BCPS

  3. Anticoagulation Stewardship Program, University of Wisconsin Hospital and Clinics, 600 Highland Ave., Madison, WI, 53792, USA

    Anne E. Rose PharmD

Authors
  1. Melissa E. Heim PharmD
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  2. Nathan Sippel PharmD, BCPS
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  3. Anne E. Rose PharmD
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Corresponding author

Correspondence to Anne E. Rose PharmD .

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Editors and Affiliations

  1. Madison, Wisconsin, USA

    Anne Rose

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© 2015 Springer International Publishing Switzerland

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Heim, M.E., Sippel, N., Rose, A.E. (2015). Anticoagulation Management in the Emergency Department. In: Rose, A. (eds) Anticoagulation Management. Adis, Cham. https://doi.org/10.1007/978-3-319-22602-6_10

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