Skip to main content

Advertisement

SpringerLink
Log in

Implementation and evaluation of a pharmacy-led thromboprophylaxis campaign in a community hospital

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

In hospitalized patients, venous thromboembolism (VTE) is an important cause of morbidity and mortality. Despite evidence demonstrating efficacy and safety of pharmacological thromboprophylaxis in the prevention of VTE, its use remains low. The aim of this study is to compare the incidence of use of thromboprophylaxis before and after a pharmacy-led thrombosis prevention campaign in medical patients hospitalized in a community hospital. A pharmacy-led multifaceted thromboprophylaxis campaign including continuing education activities for physicians and pharmacists and individualized academic detailing activities supported by clinical tools were implemented over an 8-week period. In a quasi-experimental study, the incidence of pharmacological thromboprophylaxis was evaluated using a retrospective chart review and compared before and after the campaign in medical patients at high and non-high risk of VTE as defined by the American College of Chest Physicians criteria. The medical charts of 461 patients were reviewed; 66 and 58 patients were at high-risk of VTE prior to and after the campaign, respectively. After the campaign, thromboprophylaxis ordering in high-risk patients increased from 15.2 to 43.1% (adjusted OR: 6.8; 95% CI: 2.5–18.0). Thromboprophylaxis ordering in non-high risk patients was 1.8% before the campaign and 6.0% after. This increase was not statistically significant (adjusted OR: 4.6; 95% CI: 1.0–20.4). The incidence of pharmacologic thromboprophylaxis in hospitalized medical patients at high-risk of VTE increased significantly after the campaign but remained sub-optimal. Longer or a different campaign may be needed to ensure long-term optimal thromboprophylaxis use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:381S–453S

    Article  PubMed  CAS  Google Scholar 

  2. Dobesh PP (2009) Economic burden of venous thromboembolism in hospitalized patients. Pharmacotherapy 29:943–953

    Article  PubMed  Google Scholar 

  3. Enders JM, Burke JM, Dobesh PP (2002) Prevention of venous thromboembolism in acute medical illness. Pharmacotherapy 22:1564–1578

    Article  PubMed  Google Scholar 

  4. Kahn SR, Panju A, Geerts W, Pineo GF, Desjardins L, Turpie AG, Glezer S, Thabane L, Sebaldt RJ (2007) Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 119:145–155

    Article  PubMed  CAS  Google Scholar 

  5. Rahim SA, Panju A, Pai M, Ginsberg J (2003) Venous thromboembolism prophylaxis in medical inpatients: a retrospective chart review. Thromb Res 111:215–219

    Article  PubMed  CAS  Google Scholar 

  6. Halkin H, Goldberg J, Modan M, Modan B (1982) Reduction of mortality in general medical in-patients by low-dose heparin prophylaxis. Ann Intern Med 96:561–565

    PubMed  CAS  Google Scholar 

  7. Gardlund B (1996) Randomised, controlled trial of low-dose heparin for prevention of fatal pulmonary embolism in patients with infectious diseases. The Heparin Prophylaxis Study Group. Lancet 347:1357–1361

    Article  PubMed  CAS  Google Scholar 

  8. Samama MM, Cohen AT, Darmon JY, Desjardins L, Eldor A, Janbon C, Leizorovicz A, Nguyen H, Olsson CG, Turpie AG, Weisslinger N (1999) A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med 341:793–800

    Article  PubMed  CAS  Google Scholar 

  9. Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT, Goldhaber SZ (2004) Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 110:874–879

    Article  PubMed  CAS  Google Scholar 

  10. Lechler E, Schramm W, Flosbach CW (1996) The venous thrombotic risk in non-surgical patients: epidemiological data and efficacy/safety profile of a low-molecular-weight heparin (enoxaparin). The Prime Study Group. Haemostasis 26(Suppl 2):49–56

    PubMed  CAS  Google Scholar 

  11. Kleber FX, Witt C, Vogel G, Koppenhagen K, Schomaker U, Flosbach CW (2003) Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. Am Heart J 145:614–621

    Article  PubMed  CAS  Google Scholar 

  12. Dahan R, Houlbert D, Caulin C, Cuzin E, Viltart C, Woler M, Segrestaa JM (1986) Prevention of deep vein thrombosis in elderly medical in-patients by a low molecular weight heparin: a randomized double-blind trial. Haemostasis 16:159–164

    PubMed  CAS  Google Scholar 

  13. King CS, Holley AB, Jackson JL, Shorr AF, Moores LK (2007) Twice vs three times daily heparin dosing for thromboembolism prophylaxis in the general medical population: a meta analysis. Chest 131:507–516

    Article  PubMed  CAS  Google Scholar 

  14. Ibarra-Perez C, Lau-Cortes E, Colmenero-Zubiate S, Arevila-Ceballos N, Fong JH, Sanchez-Martinez R, Dominguez MV, Elizalde-Gonzalez J (1988) Prevalence and prevention of deep venous thrombosis of the lower extremities in high-risk pulmonary patients. Angiology 39:505–513

    Article  PubMed  CAS  Google Scholar 

  15. Sobieraj DM (2008) Development and implementation of a program to assess medical patients’ need for venous thromboembolism prophylaxis. Am J Health Syst Pharm 65:1755–1760

    Article  PubMed  Google Scholar 

  16. Dobesh PP, Stacy ZA (2005) Effect of a clinical pharmacy education program on improvement in the quantity and quality of venous thromboembolism prophylaxis for medically ill patients. J Manag Care Pharm 11:755–762

    PubMed  Google Scholar 

  17. Archambault M (2007) Comité d’évaluation de l’acte médical du Département de médecine générale et familiale: prophylaxie des maladies thromboemboliques. Hôpital de la Cité-de-la-Santé, Centre de santé et de services sociaux de Laval, Laval

    Google Scholar 

  18. Stinnett JM, Pendleton R, Skordos L, Wheeler M, Rodgers GM (2005) Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates. Am J Hematol 78:167–172

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dr. Lalonde is a scientist supported by the Fonds de la recherche en santé du Québec. We thank all pharmacists, physicians and archivists of Cité-de-la-Santé Hospital involved in this study, and Chantal Legris for her assistance in the preparation of this article.

Author information

Authors and Affiliations

  1. Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada

    Marie-Christine Bernier, Karine Desjardins, Josée Filiatrault, Marc-André Sauriol & Lyne Lalonde

  2. Hôpital de la Cité-de-la-Santé, Centre de santé et de services sociaux de Laval, Laval, QC, Canada

    Marie-Christine Bernier, Karine Desjardins, Josée Filiatrault, Marc-André Sauriol, Josée Martineau, Edith Gilbert & Stéphanie Caron

  3. Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, 1755 René-Laennec Blvd., Room D-S080, Laval, QC, H7M 3L9, Canada

    Lyne Lalonde

  4. Sanofi aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada

    Lyne Lalonde

Authors
  1. Marie-Christine Bernier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karine Desjardins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Josée Filiatrault
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc-André Sauriol
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Josée Martineau
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edith Gilbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stéphanie Caron
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lyne Lalonde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lyne Lalonde.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bernier, MC., Desjardins, K., Filiatrault, J. et al. Implementation and evaluation of a pharmacy-led thromboprophylaxis campaign in a community hospital. J Thromb Thrombolysis 32, 431–438 (2011). https://doi.org/10.1007/s11239-011-0614-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-011-0614-5

Keywords

Search

Navigation