Pharmacologic and Liability Considerations of Therapeutic Interchange with Low-Molecular-Weight Heparins

Therapeutic interchange (TI), a formulary management process, is used by health care systems to help contain medication costs. A scientifically defensible and pharmacoeconomically beneficial TI program adheres to rigorous criteria enforced by an institution's Pharmacy and Therapeutics Committee. In situations where adherence to essential criteria is not mandated, TI may not produce the intended clinical and economic outcomes, and in practice may have legal implications. Appropriate application of TI has been described within the position statements of certain health care organizations and associations. Due to the high cost and frequent use of low-molecular-weight heparins (LMWHs), health care institutions have identified this pharmacologic class as a potential target for TI. Currently, the application of the TI process to LMWHs is questionable. This paper reviews the TI process and explores its controversial role in the formulary management of LMWHs.

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Therapeutic interchange of low-molecular-weight heparins

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/57.19.1798 ◽

2000 ◽

Vol 57 (19) ◽

pp. 1798-1800 ◽

Cited By ~ 1

Author(s):

Luis S. Gonzalez

Keyword(s):

Molecular Weight ◽

Low Molecular Weight ◽

Low Molecular Weight Heparins ◽

Therapeutic Interchange

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Therapeutic interchange of low-molecular-weight heparins

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/57.19.1800a ◽

2000 ◽

Vol 57 (19) ◽

pp. 1800-1802

Author(s):

Kristen A. Bollinger ◽

Lee C. Vermeulen ◽

Stephanie N. Davis ◽

Eric A. Geurkink

Keyword(s):

Molecular Weight ◽

Low Molecular Weight ◽

Low Molecular Weight Heparins ◽

Therapeutic Interchange

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Automatic therapeutic substitution in a psychiatric hospital

Mental Health Clinician ◽

10.9740/mhc.n172343 ◽

2013 ◽

Vol 3 (4) ◽

pp. 180-184

Author(s):

Amy M. VandenBerg

Keyword(s):

Health Care ◽

Psychiatric Hospital ◽

Health Care Systems ◽

Therapeutic Substitution ◽

Formulary Management ◽

Care Systems

Automatic therapeutic substitution protocols have become common practice in health care systems in the last ten to fifteen years. These protocols can help formulary management, simplify pharmacy inventory, and reduce costs. To date, psychotropics continue to be absent from the most common automatic substitution policies. This article will describe the rationale for select psychotropic substitutions.

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Formulary Management of Low Molecular Weight Heparins

PharmacoEconomics ◽

10.2165/00019053-200017010-00001 ◽

2000 ◽

Vol 17 (1) ◽

pp. 1-12 ◽

Cited By ~ 7

Author(s):

William E. Wade ◽

Bradley C. Martin ◽

Jeffrey A. Kotzan ◽

William J. Spruill ◽

Marie A. Chisoholm ◽

...

Keyword(s):

Molecular Weight ◽

Low Molecular Weight ◽

Low Molecular Weight Heparins ◽

Formulary Management

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Monitoring Low Molecular Weight Heparins with antiXa Activity: House of Cards or Firm Foundation?

Hospital Pharmacy ◽

10.1177/001857870303800302 ◽

2003 ◽

Vol 38 (3) ◽

pp. 202-211 ◽

Cited By ~ 2

Author(s):

Gilles L. Fraser ◽

Joe P. Mckenna

Keyword(s):

Health Care ◽

Molecular Weight ◽

Drug Therapy ◽

Critically Ill ◽

Critically Ill Patient ◽

Low Molecular Weight ◽

Low Molecular Weight Heparins ◽

Icu Patients ◽

House Of Cards ◽

The Impact

This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient — an area of health care that has become increasingly complex. It will review recent advances (including evolving and controversial data) in drug therapy for adult ICU patients and assess these new modalities in terms of clinical, humanistic, and economic outcomes.

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