ASHP Therapeutic Position Statement on the Role of Pharmacotherapy in Preventing Venous Thromboembolism in Hospitalized Patients

Mahan, Charles E.; Spyropoulos, Alex C.

doi:10.2146/ajhp120236

Cited by 14 publications

(12 citation statements)

References 164 publications

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“…Those with a favorable risk-benefit profile should have chemoprophylaxis administered. [12][13][14][15] However, data indicate the majority of eligible inpatients do not receive chemoprophylaxis. [16][17][18] Physicians who purposely withhold chemoprophylaxis in eligible patients cite concern over bleeding risk as their rationale.…”

Section: Introductionmentioning

confidence: 99%

Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Hostler

Moores

et al. 2016

Chest

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Section: Introductionmentioning

confidence: 99%

Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Hostler

Moores

et al. 2016

Chest

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“…The American Society of Health-System Pharmacists suggests initiating thromboprophylaxis within 24 h of admission to the hospital. [ 19 ] This highlights the suboptimal adherence to thromboprophylaxis guidelines and calls for their stricter implementation.…”

Section: Discussionmentioning

confidence: 99%

Prophylaxis and incidence of symptomatic deep vein thrombosis in indian patients with sepsis: DETECT-deep vein thrombosis registry

Ramakrishnan

Investigators

2017

Indian Journal of Critical Care Medicine

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Purpose:To assess thromboprophylaxis rate and incidence of symptomatic deep vein thrombosis (DVT) in Indian patients with acute sepsis.Materials and Methods:Adult patients with sepsis, within 48 h of sepsis onset/hospital admission were included. DVT was assessed using Doppler ultrasonography if clinical signs were present. Data were collected at inclusion, discharge, and 30 ± 7 days (if discharged before 30 days).Results:The study included 278 patients (men: 69.4%; mean age: 56.3 ± 17.99 years). Out of 275 patients (data missing for 3 patients), 188 (68.4%; 95% confidence interval: 62.5–73.8) received DVT prophylaxis (185 at admission and 3 at discharge; pharmacological prophylaxis: n = 88, mechanical prophylaxis: n = 65, pharmacological + mechanical prophylaxis: n = 35) and 87 received no prophylaxis. In line with American College of Chest Physicians 2008 recommendations, among patients who received pharmacological prophylaxis (n = 123), low-molecular-weight heparin was given to 85.4% (n = 105) patients (duration: 9.1 ± 6.36 days), unfractionated heparin to 12.2% (n = 15) patients (duration: 9.2 ± 9.18 days), and fondaparinux to 5.7% (n = 7) patients (duration: 6.8 ± 3.30 days); 27/63 patients at high-risk of bleeding received mechanical prophylaxis; no patient received aspirin. Of 9 patients who developed DVT, 7 received no thromboprophylaxis (data missing for 2 patients). In total, 186/274 (67.9%) patients recovered from sepsis.Conclusions:Two-third patients received thromboprophylaxis. The substantial role of thromboprophylaxis in DVT prevention mandates monitoring and control of thromboprophylaxis through internal audits in hospitals.

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“…Within the past 5 years, 4 DOACs have been approved in the United States for the treatment and secondary prevention of VTE: the direct thrombin inhibitor dabigatran and direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban (indications and dosing in Table 1 ). 5 - 10 The principal advantages of these agents over warfarin are a rapid onset of action, reaching maximal anticoagulant activity within 1 to 4 hours 11 - 13 ; predictable and stable pharmacokinetics and pharmacodynamics with exposure-proportional increases in anticoagulant response; and the lack of need to routinely dose monitor ( Table 2 ). 5 - 37 …”

Section: Doacs In the Treatment Of Acute Vtementioning

confidence: 99%

“…As with warfarin therapy, transitioning from injectable therapy is still necessary for dabigatran and edoxaban in the treatment of VTE, and pharmacists can play an invaluable role in ensuring successful bridging with parenteral therapies and transition to the proper dose of oral anticoagulation. 8 , 95 Finally, pharmacists should be committed to monitoring and reporting any significant side effects seen with these agents because this will ultimately improve overall patient safety with these agents.…”

Section: Role Of the Pharmacist In Vte Treatmentmentioning

confidence: 99%

Management of Venous Thromboembolism

2016

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Objective: To review clinical data on direct oral anticoagulants (DOACs) used in the acute treatment of venous thromboembolism (VTE) as well as practical considerations when using these products. Data Sources: Searches of PubMed and Google Scholar for VTE, deep vein thrombosis, pulmonary embolism, and relevant drug international nonproprietary names were conducted. Additional online searches were conducted for prescribing information. Study Selection and Data Extraction: Relevant articles on dabigatran, rivaroxaban, apixaban, and edoxaban for the management of VTE compared with oral vitamin K antagonists (VKAs; published between 1966 and December 2015) were reviewed and summarized, together with information on dosing, pharmacokinetics/pharmacodynamics, and drug-drug interactions. Data Synthesis: The DOACs have the potential to circumvent many of the disadvantages of VKAs. At a minimum, they greatly increase the available therapeutic options, thus providing a greater opportunity for clinicians to select a management option that best fits the needs of individual patients. Despite the significant advance that DOACs represent, they are not without risk and require careful consideration of a number of clinical issues to optimize safety and efficacy. Conclusions: The emergence of DOACs for the management of thromboembolic disorders represents a paradigm shift from oral VKAs. The DOACs provide similar efficacy and improved safety in selected patients as compared with VKAs. Clinicians treating VTE need to be familiar with the intricacies involved in using these agents, including the appropriate dose selection for the relevant indication, avoidance of drug-drug and drug-disease interactions, and consideration of dose adjustments in specific clinical situations, such as organ dysfunction.

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ASHP Therapeutic Position Statement on the Role of Pharmacotherapy in Preventing Venous Thromboembolism in Hospitalized Patients

Cited by 14 publications

References 164 publications

Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Prophylaxis and incidence of symptomatic deep vein thrombosis in indian patients with sepsis: DETECT-deep vein thrombosis registry

Management of Venous Thromboembolism

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