717 The Introduction of a Discharge Letter Proforma For Hip Fracture Patients Improves Compliance with VTE Prophylaxis Prescription on Discharge: A Closed Loop Audit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Williamson ◽  
C Brennan
Keyword(s):  
Hip Fracture ◽  
Marked Improvement ◽  
Closed Loop ◽  
Low Molecular Weight ◽  
Local Policy ◽  
Vte Prophylaxis ◽  
Discharge Letter ◽  
Lower Limb Surgery ◽  
Audit Cycle ◽  
Appropriate Prescription

Abstract Introduction Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in inpatients; with those undergoing lower limb surgery at particularly high risk. NICE recommends that Low Molecular Weight Heparin (LMWH) or Fondaparinux should be used for VTE prophylaxis for one month following hip fracture. Our local policy is to prescribe Dalteparin for 30 days following surgery. Method A closed loop audit of VTE prophylaxis on discharge for 193 patients with hip fractures was performed. The first audit cycle established whether VTE prophylaxis was being prescribed in line with departmental policy. Following this, a template discharge letter was introduced which included a prompt for appropriate prescription of VTE prophylaxis. Results Initially, data for 93 consecutive patients was collected. It was found that 13% had not received VTE prophylaxis in line with guidelines. Of these, six patients had no documented contraindication or alternative prophylaxis prescribed. Results were disseminated locally. After introduction of the template discharge letter, data for 100 consecutive patients was collected. Re-audit showed a marked improvement in adherence to local policy with 95% of patients now receiving appropriate VTE prophylaxis on discharge. Conclusions Introduction of a template discharge letter prompts the documentation of contraindications to prophylaxis and improves compliance with local policy.

Venous thromboembolism in a general hospital. An update with low molecular weight heparin prophylaxis

VASA ◽  
2007 ◽  
Vol 36 (1) ◽  
pp. 17-22
Author(s):  
Schulz ◽  
Kesselring ◽  
Seeberger ◽  
Andresen
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Low Molecular Weight ◽  
Trauma Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Patients At Risk ◽  
Hospital Stays ◽  
Event Rates

Background: Patients admitted to hospital for surgery or acute medical illnesses have a high risk for venous thromboembolism (VTE). Today’s widespread use of low molecular weight heparins (LMWH) for VTE prophylaxis is supposed to have reduced VTE rates substantially. However, data concerning the overall effectiveness of LMWH prophylaxis is sparse. Patients and methods: We prospectively studied all patients with symptomatic and objectively confirmed VTE seen in our hospital over a three year period. Event rates in different wards were analysed and compared. VTE prophylaxis with Enoxaparin was given to all patients at risk during their hospital stay. Results: A total of 50 464 inpatients were treated during the study period. 461 examinations were carried out for symptoms suggestive of VTE and yielded 89 positive results in 85 patients. Seventy eight patients were found to have deep vein thrombosis, 7 had pulmonary embolism, and 4 had both deep venous thrombosis and pulmonary embolism. The overall in hospital VTE event rate was 0.17%. The rate decreased during the study period from 0.22 in year one to 0,16 in year two and 0.13 % in year three. It ranged highest in neurologic and trauma patients (0.32%) and lowest (0.08%) in gynecology-obstetrics. Conclusions: With a simple and strictly applied regimen of prophylaxis with LMWH the overall rate of symptomatic VTE was very low in our hospitalized patients. Beside LMWH prophylaxis, shortening hospital stays and substantial improvements in surgical and anasthesia techniques achieved during the last decades probably play an essential role in decreasing VTE rates.

PS-100 Venous thromboembolism (VTE) prophylaxis for hospitalised medical patients (HMP) with low molecular weight heparin (LMWH)

2015 ◽  
Vol 22 (Suppl 1) ◽  
pp. A176.1-A176
Author(s):  
FI Ferreira Tátá ◽  
MA Pires Rebelo ◽  
ML Grenho Pereira ◽  
NM Ribeiro Landeira ◽  
SM Dias Fanica ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Vte Prophylaxis

Low-Molecular-Weight Heparin in Cancer Patients: Overview and Indications

2019 ◽  
Vol 39 (01) ◽  
pp. 067-075 ◽  
Author(s):  
Minna Voigtlaender ◽  
Florian Langer
Keyword(s):  
Molecular Weight ◽  
Cancer Patients ◽  
Anticancer Agents ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Increased Risk

AbstractAlthough venous thromboembolism (VTE) is a well-known cause of death in patients with cancer, both its treatment and prevention remain a challenge in daily practice. Direct oral anticoagulants have emerged as safe and efficacious alternatives to vitamin K antagonists in the general population, and recent clinical trials also support their use in select patients with cancer-associated VTE. Despite this, low-molecular-weight heparins (LMWHs), a comparatively ancient class of antithrombotic drugs, remain the anticoagulants of choice in many indications relevant to modern haematology and oncology. In addition to the treatment of established VTE, these indications include VTE prophylaxis in surgical or acutely ill, hospitalized medical cancer patients as well as the prevention of VTE in high-risk patients undergoing ambulatory chemotherapy. In a constantly changing landscape of approved anticancer agents, this review article summarizes pivotal clinical trial data and guideline recommendations regarding the use of LMWH in haematological and oncological patients, who constitute a highly vulnerable patient population due to their increased risk for both bleeding and VTE recurrence.

The Thromboprophylactic Effect of a Low-Molecular-Weight Heparin (Fragmin) in Hip Fracture Surgery

1992 ◽  
Vol 278 ◽  
pp. 95-100 ◽  
Author(s):  
P. SEEST JØRGENSEN ◽  
J. BJERRE KNUDSEN ◽  
L. BROENG ◽  
L. JOSEPHSEN ◽  
P. BJERREGAARD ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Hip Fracture ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

68 A Full Audit Cycle: Documentation of Discharge Summaries and Functional Status in Electronic Discharge Letters

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
A Mir ◽  
S Damany ◽  
H S Tay
Keyword(s):  
Hospital Admission ◽  
Functional Status ◽  
Discharge Summary ◽  
Smooth Transition ◽  
Missing Information ◽  
Discharge Letter ◽  
Audit Cycle ◽  
Comparative Results ◽  
Discharge Summaries

Abstract Introduction Electronic discharge letter is the most effective way to handover to General Practitioners for the continuity of care by providing the information about what happened during hospitalisation and what needs to happen after discharge. Well written discharge letters prevent miscommunication, missing information and medications errors as well as reduction of hospital workload. It also provides timely follow up to decrease the risk of re-hospitalisation. The aim of this project is to analyse the documentation of discharge summaries and functional status after hospital admission in discharge letters. Discharge summary template was introduced and made compulsory in all Geriatric wards following first cycle of audit. We then compared data after introduction of discharge summary template. Methods Electronic discharge letters were reviewed for all patients discharged from Geriatric Department in July 2019 and results were compared with data from January 2019. Results 162 patients were discharged in the second cycle of audit. Among these, 18 patients were deceased, and 4 patients had no discharge letters available. Therefore, total number of discharge letters analysed was 140. Please see Table 1 for comparative results on documentation of discharge summaries in discharge letters. Conclusions Introduction of the discharge summary template improved the documentation of summaries in discharge letters. Well-written discharge letter ensures the smooth transition for when patients leave the hospital. Therefore, it should be accurate, precise and relevant.

Efficacy and Safety of VTE Prophylaxis with Oral Rivaroxaban Compared to Fondaparinux or Low-Molecular Weight Heparin In a Large Cohort of Consecutive Patients Undergoing Major Orthopaedic Surgery

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 210-210
Author(s):  
Jan Beyer-Westendorf ◽  
Lars Donath ◽  
Jörg Lützner ◽  
Sebastian Werth ◽  
Oliver Radke ◽  
...  
Keyword(s):  
Orthopaedic Surgery ◽  
Low Molecular Weight Heparin ◽  
Phase Iii ◽  
Bleeding Complications ◽  
Low Molecular Weight ◽  
Severe Bleeding ◽  
Efficacy And Safety ◽  
Vte Prophylaxis ◽  
Superior Efficacy ◽  
Major Orthopaedic Surgery

Abstract Abstract 210 Efficacy and safety of VTE prophylaxis with oral rivaroxaban compared to fondaparinux or low-molecular weight heparin in a large cohort of consecutive patients undergoing major orthopaedic surgery. Aim: Patients undergoing major orthopaedic surgery (MOS) have a high risk of postoperative venous thromboembolism (VTE). Several types of pharmacological thromboprophylaxis are approved for this indication. In phase III VTE prevention trials in MOS, the new oral facor Xa inhibitor rivaroxaban proved superior efficacy over LMWH in preventing VTE without increasing bleeding complications. However, study populations consist of selected patients screened for strict exclusion criteria before randomisation. Little is known about efficacy and safety of rivaroxaban prophylaxis in large unselected cohorts of patients undergoing MOS in daily practice. Method: We retrospectively evaluated 5346 consecutive patients undergoing MOS at our centre between January 2005 and June 2011 for the rate of VTE events, bleeding complications and surgical revisions by review of patient charts, complication and transfusion databases and autopsy reports. All events were analyzed according to the type of thromboprophylaxis used. Results: Of the 5346 patients, 1055 patients received thromboprophylaxis with rivaroxaban (R; hospital standard since 2010), 1683 patients received LMWH (hospital standard 2005–2007), 2069 received fondaparinux (F; hospital standard 2007–2009) and 539 patients received other prophylaxis. Symptomatic VTE event rates for patients receiving R, F or LMWH were 2.5%, 5.5% and 3.9%, respectively (table 1). R was significantly more effective to prevent symptomatic VTE compared to F or LMWH, mostly due to significantly lower rates of distal VTE. Overall, the safety of VTE prophylaxis with R was superior over F or LMWH with significantly lower rates of surgical revisions (1.1%, 1.8% and 4.7%, respectively) and lower rates of severe bleeding complications (7.4%, 11.1% and 14.9%, respectively, which also was statistically significant. Conclusion: VTE prophylaxis with rivaroxaban is superior over prophylaxis with fondaparinux or LMWH with regard to the prevention of symptomatic VTE complications. Furthermore, rivaroxaban prophylaxis was also safer with regard to severe bleeding complications and surgical complications compared to fondaparinux or LMWH, which is in contrast to the results of large phase III trials and the current opinion, that superior efficacy of prophylaxis has the downside of higher bleeding complications. We conclude that real world patients undergoing MOS are different from study populations and may especially benefit from rivaroxaban prophylaxis with regard to both efficacy and safety. Disclosures: Beyer-Westendorf: Bayer Healthcare: Research Funding, Speakers Bureau.

Combined modalities in the prevention of venous thromboembolism: A review of the literature

2006 ◽  
Vol 21 (1_suppl) ◽  
pp. 23-28 ◽  
Author(s):  
S K Kakkos ◽  
J A Caprini ◽  
A N Nicolaides ◽  
D Reddy
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Groups ◽  
Intermittent Pneumatic Compression ◽  
Low Molecular Weight ◽  
Review Of The Literature ◽  
Case Control Studies ◽  
Vte Prophylaxis ◽  
Risk Patients ◽  
Elastic Stockings

Objective Despite recent advances in the field of venous thromboembolism (VTE) prophylaxis and adherence to guideline recommendations, VTE remains a serious problem, especially in high-risk groups. The aim of the present review was to summarize the evidence supporting the use of combined modalities, both physical and pharmacological, in VTE prevention. Methods Using Medline, original studies on the value of combined modalities in VTE prevention were identified. Keywords used for physical methods included elastic stockings and intermittent pneumatic compression, and for pharmacological methods included unfractionated and low molecular weight heparin. Relevant articles from their bibliography were also retrieved. Results Combined pharmacological and physical modalities were more effective than each modality alone in a variety of specialties, including orthopaedic, general and cardiac surgery, as shown by 14 of the 18 randomized or case-control studies retrieved. Mean reduction in VTE incidence was 69% (range 16–100%). Conclusion Combined modalities are more effective than single modalities in VTE prophylaxis. These results endorse their use, especially in high-risk patients, and support this otherwise typical recommendation of the consensus documents on VTE prophylaxis.

scholarly journals Iron Catalyzed Synthesis and Chemical Recycling of Telechelic, 1,3-Enchained Oligocyclobutanes

2020 ◽  
Author(s):  
Megan Mohadjer Beromi ◽  
C. Rose Kennedy ◽  
Jarod M. Younker ◽  
Alex E. Carpenter ◽  
Sarah J. Mattler ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Closed Loop ◽  
Building Blocks ◽  
Plastic Waste ◽  
Low Molecular Weight ◽  
Chemical Recycling ◽  
Thermally Stable ◽  
Hydrocarbon Feedstock ◽  
High Crystallinity

Closed-loop recycling offers the opportunity to help mitigate plastic waste through reversible polymer construction and deconstruction. While examples of the chemical recycling polymers are known, few have been applied to materials derived from abundant commodity olefinic monomers that are the building blocks of ubiquitous plastic resins. Here we describe a [2+2] cycloaddition oligomerization of 1,3-butadiene to yield a previously unrealized telechelic microstructure of (1,n’-divinyl)oligocyclobutane. This material is thermally stable, has stereoregular segments arising from chain-end control, and exhibits high crystallinity even at low molecular weight. Exposure of the oligocyclobutane to vacuum in the presence of the pyridine(diimine) iron precatalyst used to synthesize it resulted in deoligomerization to generate pristine butadiene, demonstrating a rare example of closed-loop chemical recycling of an oligomeric material derived from a commodity hydrocarbon feedstock.

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