Contemporary Issues in the Prevention and Management of Postthrombotic Syndrome

Academic Emergency Medicine

et al. 2017

Abstract:Objective. To describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using rivaroxaban versus care by a primary care provider.Interventions. Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with rivaroxban and follow up either in a pharmacist-managed VTE clinic or with their primary care provider. Pharmacists in the VTE clinic work independently under a collaborative practice agreement. An evaluation of thirty-four patients, seventeen in each treatment arm, was conducted to compare the differences in treatment-related outcomes of rivaroxaban when managed by a pharmacist versus a primary care provider.Results. The primary endpoint was a six month composite of anticoagulation treatmentrelated complications that included a diagnosis of major bleeding, recurrent thromboembolism, or fatality due to either major bleeding or recurrent thromboembolism. Secondary endpoints included number of hospitalizations, adverse events, and medication Accepted ArticleThis article is protected by copyright. All rights reserved.adherence. There was no difference in the primary endpoint between groups with one occurrence of the composite endpoint in each treatment arm (p=1.000), both of which were recurrent thromboembolic events. Medication adherence assessment was formally performed in 8 patients in the pharmacist group versus 0 patients in the control group. No differences were seen amongst other secondary endpoints.Conclusions. The pharmacist-managed clinic is a novel expansion of clinical pharmacy services that treats patients with low-risk VTEs with rivaroxaban in the outpatient setting.The evaluation of outcomes provides support that pharmacist-managed care utilizing standardized protocols under a collaborative practice agreement may be as safe as care by a primary care provider. Introduction:

Section: Methodsmentioning

confidence: 99%

Implementation and Preliminary Clinical Outcomes of a Pharmacist‐managed Venous Thromboembolism Clinic for Patients Treated With Rivaroxaban Post Emergency Department Discharge

DiRenzo

Beam

Academic Emergency Medicine

et al. 2017

“…In addition to risk of death, patients with submassive PE may suffer persistent right ventricular dysfunction that can impair their quality of life by causing dyspnea and exercise intolerance . If associated with deep vein thrombosis, their quality of life can be further degraded by the post‐thrombotic syndrome . We therefore designed a primary composite outcome from the perspective of the patient: to survive the PE without need for life supporting interventions in hospital and on follow‐up, and at 90 days to have good functional capacity (defined as normal right ventricular function on echocardiography, a New York Heart Association functional class better than 3, and adequate exercise tolerance on 6‐min walk test) and perception of wellness on the physical component portion of the SF‐36 no worse than two standard deviations below normal .…”

Section: Introductionmentioning

confidence: 99%

Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double‐blind, placebo‐controlled randomized trial

Journal of Thrombosis and Haemostasis

Nordenholz

Courtney

et al. 2014

240

155

of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double-blind, placebocontrolled randomized trial. J Thromb Haemost 2014; 12: 459-68.Summary. Background: Acute pulmonary embolism (PE) can worsen quality of life due to persistent dyspnea or exercise intolerance. Objective: Test if tenecteplase increases the probability of a favorable composite patient-oriented outcome after submassive PE. Methods: Normotensive patients with PE and right ventricular (RV) strain (by echocardiography or biomarkers) were enrolled from eight hospitals. All patients received lowmolecular-weight heparin followed by random assignment to either a single weight-based bolus of tenecteplase or placebo, administered in a double-blinded fashion. The primary composite outcome included: (i) death, circulatory shock, intubation or major bleeding within 5 days or (ii) recurrent PE, poor functional capacity (RV dysfunction with either dyspnea at rest or exercise intolerance) or an SF36â Physical Component Summary (PCS) score < 30 at 90-day follow-up. Results: Eighty-three patients were randomized; 40 to tenecteplase and 43 to placebo. The trial was terminated prematurely. Within 5 days, adverse outcomes occurred in three placebo-treated patients (death in one and intubation in two) and one tenecteplase-treated patient (fatal intracranial hemorrhage). At 90 days, adverse outcomes occurred in 13 unique placebo-treated patients and five unique tenecteplase-treated patients Thus, 16 (37%) placebo-treated and six (15%) tenecteplase-treated patients had at least one adverse outcome (exact two-sided P = 0.017). Conclusions: Treatment of patients with submassive pulmonary embolism with tenecteplase was associated with increased probability of a favorable composite outcome.

“… Post‐thrombotic syndrome . Whether or not leg deep vein thrombosis is objectively documented, approximately 5–7% of patients with PE experience a reduction in quality of life from moderate to severe post‐thrombophlebitic syndrome that includes limited mobility and symptoms of leg heaviness, swelling, and pain Perception of wellness .…”

Section: Introductionmentioning

confidence: 91%

Rationale and methodology for a multicentre randomised trial of fibrinolysis for pulmonary embolism that includes quality of life outcomes

Emerg Medicine Australasia

Hernandez

Hogg

et al. 2013

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