PMID- 18653824
OWN - NLM
STAT- MEDLINE
DCOM- 20080902
LR  - 20190101
IS  - 1535-2900 (Electronic)
IS  - 1079-2082 (Linking)
VI  - 65
IP  - 15 Suppl 7
DP  - 2008 Aug 1
TI  - Improving the use of anticoagulant therapies in acutely ill medical patients.
PG  - S5-12
LID - 10.2146/ajhp080240 [doi]
AB  - PURPOSE: Assessment of risk for the development of venous thromboembolism (VTE), 
      selection of VTE prophylaxis in medical patients, strategies for improving 
      prescribing practices to prevent VTE, and the impact of pharmacist-managed 
      anticoagulation services are described; case studies are used to illustrate each 
      topic. SUMMARY: Assessing risk for VTE is more complicated for acutely ill 
      medical patients than for surgical patients. The risk of VTE in medical patients 
      increases with the number of VTE risk factors the patient has. A number of 
      regimens have demonstrated efficacy in reducing the rate of VTE in medically ill 
      patients. Head-to-head studies suggest that enoxaparin 40 mg daily is at least as 
      effective as unfractionated heparin (UFH) 5000 units three times daily for 
      preventing VTE in acute medically ill patients. Because of greater efficacy, 
      enoxaparin may be preferred over UFH in certain patient populations at 
      particularly high risk for VTE. Although the efficacy of VTE prophylaxis is well 
      documented, most patients at risk still do not receive this therapy. A 
      combination of strategies is more effective than a single strategy for modifying 
      prescribing practices to ensure that optimal VTE prophylaxis is provided when 
      indicated. Pharmacist-managed anticoagulation services improve the appropriate 
      use of anticoagulant agents, shorten hospital length of stay, and reduce 
      mortality, drug-related complications, hospital readmissions for bleeding and 
      thrombosis, and costs. CONCLUSION: Pharmacists can improve clinical and economic 
      outcomes in acutely ill medical patients who are at risk for VTE through the use 
      of various strategies, including anticoagulation management services.
FAU - Dobesh, Paul P
AU  - Dobesh PP
AD  - College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska 
      68135-6045, USA. pdobesh@unmc.edu
FAU - Phillips, Katherine W
AU  - Phillips KW
FAU - Haines, Stuart T
AU  - Haines ST
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Critical Illness
MH  - Female
MH  - Humans
MH  - Medication Therapy Management
MH  - Middle Aged
MH  - *Pharmacy Service, Hospital
MH  - Risk Assessment
MH  - Venous Thromboembolism/drug therapy/*prevention & control
EDAT- 2008/07/31 09:00
MHDA- 2008/09/03 09:00
CRDT- 2008/07/31 09:00
PHST- 2008/07/31 09:00 [pubmed]
PHST- 2008/09/03 09:00 [medline]
PHST- 2008/07/31 09:00 [entrez]
AID - 65/15_Supplement_7/S5 [pii]
AID - 10.2146/ajhp080240 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2008 Aug 1;65(15 Suppl 7):S5-12. doi: 10.2146/ajhp080240.