Abstract
Hospital-acquired venous thromboembolism (VTE) is associated with increased morbidity, mortality, and medical costs. It is considered one of the most common preventable causes of death in hospitalized patients. While most hospitalized patients will have at least one risk factor for developing VTE, not all factors have the same weighted risk associated with causing VTE. VTE risk assessment models were created to help assist providers with identifying high VTE risk patients. When it comes to selecting preventative therapies, there are many options for both pharmacologic and mechanical strategies.
This chapter will focus on how the pharmacist can use their clinical skills to assist with identifying high VTE risk patients and selection of the most appropriate strategy to prevent VTE based on individual patient-specific risk factors.
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References
Qaseem A, Chou R, Humphrey LL et al (2011) Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American college of physicians. Ann Intern Med 155:625–632
Eymin G, Jaffer AK (2014) Evidence behind quality of care measures for venous thromboembolism and atrial fibrillation. J Thromb Thrombolysis 37:87–96
Spyropoulos AC, Lin J (2007) Direct medical cost of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations. J Manag Care Pharm 13(6):475–486
Mahan CE, Borrego ME, Woersching AL et al (2012) Venous thromboembolism: annualized United States models for total, hospital acquired and preventable costs utilizing long-term attack rates. Thromb Haemost 108:291–302
Kumar DR, Hanlin E, Glurich I et al (2010) Virchow’s contribution to the understanding of thrombosis and cellular biology. Clin Med Res 8(3–4):168–172
Kahn SR, Lim W, Dunn AS et al (2012) Prevention of VTE in non-surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed. American college of chest physicians evidence based clinical practice guidelines. Chest 141:e195s–e226s
Gould MK, Garcia DA, Wren SM et al (2012) Prevention of VTE in non-orthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed. American college of chest physicians evidence based clinical practice guidelines. Chest 141:e227s–e277s
Amin A, Stemkowski S, Lin J et al (2007) Thromboprophylaxis rates in US medical centers: success or failure? J Thromb Haemost 5:1610–1616
Kahn SR, Panju A, Geerts W et al (2007) Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 119:145–155
Cohen AT, Tapson VF, Bergmann JF et al (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multi-national cross-sectional study. Lancet 371:387–394
Kakkar AK, Davidson BL, Haas SK (2004) Compliance with recommended prophylaxis for venous thromboembolism: improving the use and rate of uptake of clinical practice guidelines. J Thromb Haemost 2:221–227
Amin A, Spyropoulos AC, Dobesh P et al (2010) Are hospitals delivering appropriate VTE prevention? The venous thromboembolism study to assess the rate of thromboprophylaxis (VTE Start). J Thromb Thrombolysis 29:326–339
National Quality Forum (2003) Safe practices for better health care: a consensus report. Available at: www.qualityforum.org. Accessed 10 Dec 2014
The Joint Commission (2014) 2014 hospital national patient safety goals [Internet]. http://jointcommission.org/assets/1/6/2014_HAFP_NPSG_E.pdf. Accessed 4 Nov 2014
The Centers for Medicare and Medicaid Services (2014) 2014 definition of stage 1 of meaningful use. http://www.cms.gov/regulations-and-guidance/legislation/EHRincentiveprograms/ meaningful_use.html. Accessed 10 Dec 2014
Bauer JB, Chun DS, Karpinski TA (2008) Pharmacist-led program to improve venous thromboembolism prophylaxis in a community hospital. Am J Health Syst Pharm 65:1643–1647
Maynard G, Stein J (2010) Designing and implementing effective venous thromboembolism prevention protocols: lessons from collaborative efforts. J Thromb Thrombolysis 29:159–166
Goldhaber S (2010) Eradication of hospital-acquired venous thromboembolism. Thromb Haemost 104:1089–1092
Michtalik HJ, Carolan HT, Haut ER et al (2014) Use of provider-level dashboard and pay-for-performance in venous thromboembolism prophylaxis. J Hosp Med 10:172–178
Maynard GA, Morris TA, Jenkins IH et al (2010) Optimizing prevention of hospital-acquired venous thromboembolism (VTE): prospective validation of a VTE risk assessment model. J Hosp Med 5:10–18
Barba R, Zapatero A, Losa JE et al (2010) Venous thromboembolism in acutely ill hospitalized medical patients. Thromb Res 126:276–279
Lilly CM, Liu X, Badawi O et al (2014) Thromboprophylaxis and mortality risk among critically ill adults. Chest 146(1):51–57
Bernstein CN, Blanchard JF, Houston DS et al (2001) The incidence of deep vein thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population based cohort study. Thromb Haemost 85:430–434
Kappelman MD, Horvath-Puho E, Sandler RS et al (2011) Thromboembolic risk among Danish children and adults with inflammatory bowel diseases: a population-based nationwide study. Gut 60:937–943
Saibeni S, Saladino V, Chantarangkul V et al (2010) Increased thrombin generation in inflammatory bowel diseases. Thromb Res 125:278–282
Collins CE, Cahill MR, Newland AC et al (1994) Platelets circulate in an active states in inflammatory bowel disease. Gastroenterology 106:840–845
Gris JC, Schved JF, Raffanel C et al (1990) Impaired fibrinolytic capacity in patients with inflammatory bowel disease. Thromb Haemost 63:472–475
Dwyer JP, Javed A, Hair CS et al (2014) Venous thromboembolism and underutilization of anticoagulation thromboprophylaxis in hospitalized patients with inflammatory bowel disease. Intern Med J 44(8):779–784
Rogers SO, Kilaru RK, Hosokawa P et al (2007) Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204(6):1211–1221
Caprini JA (2005) Thrombosis risk assessment as a guide to quality patient care. Dis Mon 51:70–78.
Bahl V, Hu HM, Henke PK et al (2010) A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg 251(2):344–350
Turpie AG, Lassen MR, Eriksson BI et al (2011) Rivaroxaban for the prevention of venous thromboembolism after hip or knee arthroplasty. Pooled analysis of four studies. Thromb Haemost 105(3):444–453
Cohen AT, Spiro TE, Buller HR, Haskell L, Hu D, Hull R, Mebazaa A, Merli G, Schellong S, Spyropoulos AC, Tapson V (2013) Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med 368:513–523
Lassen MR, Gallus A, Raskob GE et al (2010) Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med 363:2487–2498
Lassen MR, Raskob GE, Gallus A et al (2010) Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomized double-blind trial. Lancet 375(9717):807–815
Goldhaber SZ, Leizorovicz A, Kakkar AK et al (2011) Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med 365(23):2167–2177
Prandoni P, Temraz S, Taher A (2014) Direct oral anticoagulants in the prevention of venous thromboembolism: evidence from major clinical trials. Semin Hematol 51:121–130
Phung OJ, Kahn SR, Cook DJ et al (2011) Dosing frequency of unfractionated heparin thromboprophylaxis: a meta-analysis. Chest 140(2):374–381
Garcia DA, Baglin TP, Weitz JI et al (2012) Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e24S–e43S
Douketis J, Cook D, Meade M et al (2008) Prophylaxis against deep vein thrombosis in critically ill patients with severe renal insufficiency with the low molecular weight heparin dalteparin: an assessment of safety and pharmacodynamics: the Direct study. Arch Intern Med 168(16):1805–1812
Scholten DJ, Hoedema RM, Scholten SE (2012) A comparison of two different prophylactic dose regimens of low molecular weight heparin in bariatric surgery. Obes Surg 12:19–24
Wang T, Milligan PE, Wong CA et al (2014) Efficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients. Thromb Haemost 111:88–93
Nutescu EA, Spinler SA, Wittkowsky A et al (2009) Low-molecular-weight heparins in renal impairment and obesity: available evidence and clinical practice recommendations across medical and surgical settings. Ann Pharmacother 43:1064–1083
Duplaga BA, Rivers CW, Nutescu E (2001) Dosing and monitoring of low-molecular-weight heparins in special populations. Pharmacotherapy 21:218–234
Wallis DE, Workman DL, Lewis BE et al (1999) Failure of early heparin cessation as treatment for heparin induced thrombocytopenia. Am J Med 106:629–635
Chong BH (2003) Heparin-induced thrombocytopenia. J Thromb Haemost 1:1471–1478
Eriksson BI, Dahl OE, Rosencher N et al (2007) Oral dabigatran etexilate vs subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 5:2178–2185
Eriksson BI, Dahl OE, Rosencher N et al (2007) Dabigatran etexilate versus enoxaparin for the prevention venous thromboembolism after total hip replacement: a randomized double blind non-inferiority trial. Lancet 370:949–956
Fuji F, Fujita S, Tachibana S et al (2010) A dosing ranging study evaluating the oral factor Xa inhibitor edoxaban for the prevention of venous thromboembolism in patients undergoing total knee arthroplasty. J Thromb Haemost 8(11):2458–2468
Raskob G, Cohen AT, Eriksson BI et al (2010) Oral direct factor Xa inhibition with edoxaban for thromboprophylaxis after elective total hip replacement. A randomized double-blind dose response study. Thromb Haemost 104(3):642–649
Lyman GH, Khorana AA, Kuderer NM et al (2013) Venous thromboembolism prophylaxis and treatment in patients with cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol 31:2189–2204
Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW (2008) Development and validation of a predictive model for chemotherapy associated thrombosis. Blood 111:4902–4907
Verso M, Agnelli G (2014) New strategies of VTE prevention in cancer patients. Thromb Res 133:s128–s132
Pannucci CJ, Laird S, Dimick JB et al (2014) A validated risk model to predict 90-day VTE events in postsurgical patients. Chest 145(3):567–573
Falck-Ytter Y, Francis CW, Johanson NA et al (2012) Prevention of VET in orthopedic surgery patients: Antithrombotic Therapy and Prevent of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e278S–e325S
Connolly GC, Khorana AA (2010) Emerging risk stratification approached to cancer-associated thrombosis: risk factors, biomarkers and a risk score. Thromb Res 125:S1–S7
Dobesh PP, Stacy ZA (2005) Effect of a clinical pharmacy education program on the improvement of the quantity and quality of venous thromboembolism prophylaxis for medically ill patients. J Manag Care Pharm 11(9):755–762
Piazza G, Nguyen TN, Morrison R et al (2012) Patient education program for venous thromboembolism prevention in hospitalized patients. Am J Med 125(3):258–264
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Rose, A.E. (2015). Prevention of Venous Thromboembolism. In: Rose, A. (eds) Anticoagulation Management. Adis, Cham. https://doi.org/10.1007/978-3-319-22602-6_6
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DOI: https://doi.org/10.1007/978-3-319-22602-6_6
Publisher Name: Adis, Cham
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