Effectiveness and Safety of Twice Daily Versus Thrice Daily Subcutaneous Unfractionated Heparin for Venous Thromboembolism Prophylaxis at a Tertiary Medical Center

2020 ◽  
pp. 089719002096121
Author(s):  
Meghan W. Sorgi ◽  
Erin Roach ◽  
Seth R. Bauer ◽  
Stephanie Bass ◽  
Michael Militello ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Propensity Scores ◽  
Medical Center ◽  
Matched Cohort ◽  
Thromboembolism Prophylaxis ◽  
Full Cohort ◽  
Vte Prophylaxis ◽  
Major Bleed ◽  
Increased Risk

Background: The direct comparison of twice daily (BID) and thrice daily (TID) dosing of subcutaneous low dose unfractionated heparin (LDUH) for venous thromboembolism (VTE) prophylaxis in a mixed inpatient population is not well-studied. Objective: This study evaluated the effectiveness and safety of BID compared to TID dosing of LDUH for prevention of VTE. Methods: Retrospective, single-center analysis of patients who received LDUH for VTE prophylaxis between July and September 2015. Outcomes were identified by ICD-9 codes. A matched cohort was created using propensity scores and multivariate analysis was conducted to identify independent risk factors for VTE. The primary outcome was incidence of symptomatic VTE. Results: In the full cohort, VTE occurred in 0.71% of patients who received LDUH BID compared to 0.77% of patients who received LDUH TID ( p = 0.85). There was no difference in major ( p = 0.85) and minor ( p = 0.52) bleeding between the BID and TID groups. For the matched cohort, VTE occurred in 1.4% of BID patients and 2.1% of TID patients ( p = 0.32). Major bleed occurred in 0.36% of BID patients and 0.52% of TID patients ( p = 0.7), while a minor bleed was seen in 3.4% of BID patients and 2.1% of TID patients ( p = 0.13). Personal history of VTE ( p = 0.002) and weight ( p = 0.035) were independently associated with increased risk of VTE. Conclusion: This study did not demonstrate a difference in effectiveness or safety between BID and TID dosing of LDUH for VTE prevention.

The Efficacy of Dextran-40 as a Venous Thromboembolism Prophylaxis Strategy in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

2017 ◽  
Vol 83 (2) ◽  
pp. 134-140 ◽  
Author(s):  
Jason M. Foster ◽  
Richard Sleightholm ◽  
Duncan Watley ◽  
Steven Wahlmeier ◽  
Asish Patel
Keyword(s):  
Venous Thromboembolism ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Medical Center ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Thromboembolism Prophylaxis ◽  
Dextran 40 ◽  
Perioperative Bleeding ◽  
Increased Risk

The incidence of venous thromboembolism (VTE) in peritoneal malignancies can approach 30 to 50 per cent without prophylaxis. Prophylaxis in cytoreductive surgeries (CRS) presents a challenge to preoperative heparin-based therapy because of an increased risk of coagulopathy and potential for bleeding. Herein, we report the large series of CRS and hyperthermic intraperitoneal chemotherapy receiving dextran-40 prophylaxis. Retrospective chart review of peritoneal malignancies patients undergoing CRS at University of Nebraska Medical Center identified 69 individuals who received dextran-40 between 2010 and 2013. The incidences of VTEs, perioperative bleeding, complications, morbidity, and mortality were determined in-hospital and at 90 days. Of the 69 patients treated, the 30-day VTE rate was 8.7 per cent, and no pulmonary embolisms, bleeding, anaphylactoid reaction, or mortality were observed with dextran usage. The specific VTE events included three upper extremity and three lower extremity VTEs. No additional VTE events were identified between 30 and 90 days. In conclusion, dextran-40 prophylaxis was not associated with any perioperative bleeding events, and the observed incidence of VTE was comparable to reported heparin-based prophylaxis in CRS/hyperthermic intraperitoneal chemotherapy patients. This data supports further exploration of dextran-40 as a VTE prophylactic agent in complex surgical oncology cases.

Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis

2020 ◽  
Author(s):  
Herbert Chen ◽  
Irene Lou
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Bleeding Complications ◽  
Thromboembolism Prophylaxis ◽  
Therapy Management ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Perioperative Anticoagulation

The management of perioperative anticoagulation, antiplatelet therapy, and perioperative venous thromboembolism (VTE) prophylaxis is essentially a balancing act between patient risk factors for thrombosis and surgical risk factors for bleeding. The purpose of this review is to assist surgeons with the identification of patients at increased risk for thromboembolism when antithrombotic therapy is interrupted, patients for whom bridging anticoagulation should be considered, patients who require perioperative VTE prophylaxis, and patients at increased risk for bleeding complications and to briefly review the literature and major guidelines regarding perioperative antithrombotic therapy management and perioperative VTE prophylaxis. Figures show approaches to the management of perioperative anticoagulation, antiplatelet therapy, and VTE prophylaxis.  This review contains 2 figures, 7 tables, and 61 references. Keywords: Venous thromboembolism, pulmonary embolism, anticoagulation, surgery, perioperative period, prophylaxis  

scholarly journals Factors Influencing Prescribers' Decision for Extending Venous Thromboembolism Prophylaxis in the Medical Patient Population following Hospitalization

TH Open ◽  
2020 ◽  
Vol 04 (03) ◽  
pp. e218-e219
Author(s):  
Alex M. Ebied ◽  
Jeremiah Jessee ◽  
Yiqing Chen ◽  
Jason Konopack ◽  
Nila Radhakrishnan ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Medical Center ◽  
Medical Patient ◽  
Outpatient Setting ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Oral Medications ◽  
New Oral Anticoagulant ◽  
Perceived Benefit ◽  
Medicine Physician

Abstract Introduction Venous thromboembolism (VTE) prophylaxis during hospitalization has clearly defined metrics for risk stratification and practice policy employed to ensure processes of adherence. However, acceptance for practice or even the level and timeline of risk is less clear during the immediate time after hospitalization. With emerging new oral anticoagulant agents, data are available that may influence prescribing in the outpatient setting following hospitalization. A survey was created to determine the level of acceptance or influences for practice surrounding continuation of anticoagulation following hospitalization. Methods This study was designed as a single-center survey of hospitalist and family medicine physician to assess influences to the physician's impression for risk of VTE prophylaxis and knowledge of therapy options. Results Physicians reported depending heavily on medical center protocols for determining anticoagulation at hospital discharge. Prescribing postdischarge anticoagulation was reported to be affected by lack of comfort with prescribing oral medications and concerns with risk of bleeding for all types of anticoagulation outweighing the perceived benefit. Additionally, the decision whether to prescribe these medications at discharge was reported to be related to perceived cost and other patient barriers such as concerns over route of administration. Conclusion Concerns for bleeding were an influence and likely resulted in shorter duration for VTE prophylaxis being prescribed posthospitalization.

scholarly journals Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update

2020 ◽  
Vol 38 (5) ◽  
pp. 496-520 ◽  
Author(s):  
Nigel S. Key ◽  
Alok A. Khorana ◽  
Nicole M. Kuderer ◽  
Kari Bohlke ◽  
Agnes Y.Y. Lee ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Medical Condition ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Signs And Symptoms ◽  
Cochrane Library ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Increased Risk

PURPOSE To provide updated recommendations about prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. METHODS PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and meta-analyses of RCTs published from August 1, 2014, through December 4, 2018. ASCO convened an Expert Panel to review the evidence and revise previous recommendations as needed. RESULTS The systematic review included 35 publications on VTE prophylaxis and treatment and 18 publications on VTE risk assessment. Two RCTs of direct oral anticoagulants (DOACs) for the treatment of VTE in patients with cancer reported that edoxaban and rivaroxaban are effective but are linked with a higher risk of bleeding compared with low-molecular-weight heparin (LMWH) in patients with GI and potentially genitourinary cancers. Two additional RCTs reported on DOACs for thromboprophylaxis in ambulatory patients with cancer at increased risk of VTE. RECOMMENDATIONS Changes to previous recommendations: Clinicians may offer thromboprophylaxis with apixaban, rivaroxaban, or LMWH to selected high-risk outpatients with cancer; rivaroxaban and edoxaban have been added as options for VTE treatment; patients with brain metastases are now addressed in the VTE treatment section; and the recommendation regarding long-term postoperative LMWH has been expanded. Re-affirmed recommendations: Most hospitalized patients with cancer and an acute medical condition require thromboprophylaxis throughout hospitalization. Thromboprophylaxis is not routinely recommended for all outpatients with cancer. Patients undergoing major cancer surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Patients with cancer should be periodically assessed for VTE risk, and oncology professionals should provide patient education about the signs and symptoms of VTE. Additional information is available at www.asco.org/supportive-care-guidelines .

scholarly journals Minor Hematochezia Decreases Use of Venous Thromboembolism Prophylaxis in Patients with Inflammatory Bowel Disease

2019 ◽  
Vol 26 (9) ◽  
pp. 1394-1400 ◽  
Author(s):  
Adam S Faye ◽  
Kenneth W Hung ◽  
Kimberly Cheng ◽  
John W Blackett ◽  
Anna Sophia Mckenney ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Hospitalized Patients ◽  
High Yield ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Factors Associated ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Despite increased risk of venous thromboembolism (VTE) among hospitalized patients with inflammatory bowel disease (IBD), pharmacologic prophylaxis rates remain low. We sought to understand the reasons for this by assessing factors associated with VTE prophylaxis in patients with IBD and the safety of its use. Methods This was a retrospective cohort study conducted among patients hospitalized between January 2013 and August 2018. The primary outcome was VTE prophylaxis, and exposures of interest included acute and chronic bleeding. Medical records were parsed electronically for covariables, and logistic regression was used to assess factors associated with VTE prophylaxis. Results There were 22,499 patients studied, including 474 (2%) with IBD. Patients with IBD were less likely to be placed on VTE prophylaxis (79% with IBD, 87% without IBD), particularly if hematochezia was present (57% with hematochezia, 86% without hematochezia). Among patients with IBD, admission to a medical service and hematochezia (adjusted odds ratio 0.27; 95% CI, 0.16–0.46) were among the strongest independent predictors of decreased VTE prophylaxis use. Neither hematochezia nor VTE prophylaxis was associated with increased blood transfusion rates or with a clinically significant decline in hemoglobin level during hospitalization. Conclusion Hospitalized patients are less likely to be placed on VTE prophylaxis if they have IBD, and hematochezia may drive this. Hematochezia appeared to be minor and was unaffected by VTE prophylaxis. Education related to the safety of VTE prophylaxis in the setting of minor hematochezia may be a high-yield way to increase VTE prophylaxis rates in patients with IBD.

Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis

2020 ◽  
Author(s):  
Herbert Chen ◽  
Irene Lou
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Bleeding Complications ◽  
Thromboembolism Prophylaxis ◽  
Therapy Management ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Perioperative Anticoagulation

The management of perioperative anticoagulation, antiplatelet therapy, and perioperative venous thromboembolism (VTE) prophylaxis is essentially a balancing act between patient risk factors for thrombosis and surgical risk factors for bleeding. The purpose of this review is to assist surgeons with the identification of patients at increased risk for thromboembolism when antithrombotic therapy is interrupted, patients for whom bridging anticoagulation should be considered, patients who require perioperative VTE prophylaxis, and patients at increased risk for bleeding complications and to briefly review the literature and major guidelines regarding perioperative antithrombotic therapy management and perioperative VTE prophylaxis. Figures show approaches to the management of perioperative anticoagulation, antiplatelet therapy, and VTE prophylaxis.  This review contains 2 figures, 7 tables, and 61 references. Keywords: Venous thromboembolism, pulmonary embolism, anticoagulation, surgery, perioperative period, prophylaxis  

Improving the Quality of Inpatient Ulcerative Colitis Management: Promoting Evidence-Based Practice and Reducing Care Variation With an Inpatient Protocol

2019 ◽  
Vol 25 (11) ◽  
pp. 1822-1827 ◽  
Author(s):  
Sara M Lewin ◽  
Ryan A McConnell ◽  
Roshan Patel ◽  
Suzanne R Sharpton ◽  
Fernando Velayos ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Venous Thromboembolism ◽  
Oral Morphine ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Thromboembolism Prophylaxis ◽  
Disease Extent ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Evidence Based Care

Abstarct Background Hospitalization for ulcerative colitis is a high-risk period associated with increased risk of Clostridium difficile infection, thromboembolism, and opiate use. The study aim was to develop and implement a quality-improvement intervention for inpatient ulcerative colitis management that standardizes gastroenterology consultant recommendations and improves delivery of evidence-based care. Methods All adult patients hospitalized for ulcerative colitis between July 1, 2014, and December 31, 2017, who received intravenous corticosteroids were included. On July 1, 2016, the UCSF Inpatient Ulcerative Colitis Protocol was implemented, featuring standardized core recommendations and a daily checklist for gastroenterology consultant notes, a bundled IBD electronic order set, and an opiate awareness campaign. The composite primary outcome was adherence to all 3 evidence-based care metrics: C. difficile testing performed, pharmacologic venous thromboembolism (VTE) prophylaxis ordered, and opiates avoided. Results Ninety-three ulcerative colitis hospitalizations occurred, including 36 preintervention and 57 postintervention. Age, gender, disease duration, disease extent, and medication use were similar preintervention and postintervention. C. difficile testing was performed in 100% of hospitalizations. Venous thromboembolism prophylaxis was ordered on 84% of hospital days before intervention compared with 100% after intervention (P ≤ 0.001). Opiates were administered in 67% of preintervention hospitalizations, compared with 53% of postintervention hospitalizations (P = 0.18). The median daily dose of oral morphine equivalents decreased from 12.1 mg before intervention to 0.5 mg after intervention (P = 0.02). The composite outcome of adherence to all 3 metrics was higher after intervention (25% vs. 47%, P = 0.03). Conclusions Evidence-based inpatient ulcerative colitis management may be optimized with standardized algorithms that reinforce core principles, reduce care variation, and do not require IBD specialists to implement.

Perioperative Antithrombotic Therapy Management and Venous Thromboembolism Prophylaxis

2020 ◽  
Author(s):  
Herbert Chen ◽  
Irene Lou
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Bleeding Complications ◽  
Thromboembolism Prophylaxis ◽  
Therapy Management ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Perioperative Anticoagulation

The management of perioperative anticoagulation, antiplatelet therapy, and perioperative venous thromboembolism (VTE) prophylaxis is essentially a balancing act between patient risk factors for thrombosis and surgical risk factors for bleeding. The purpose of this review is to assist surgeons with the identification of patients at increased risk for thromboembolism when antithrombotic therapy is interrupted, patients for whom bridging anticoagulation should be considered, patients who require perioperative VTE prophylaxis, and patients at increased risk for bleeding complications and to briefly review the literature and major guidelines regarding perioperative antithrombotic therapy management and perioperative VTE prophylaxis. Figures show approaches to the management of perioperative anticoagulation, antiplatelet therapy, and VTE prophylaxis.  This review contains 2 figures, 7 tables, and 61 references. Keywords: Venous thromboembolism, pulmonary embolism, anticoagulation, surgery, perioperative period, prophylaxis  

scholarly journals The Current Status of Venous Thromboembolism Prophylaxis Following Total Joint Arthroplasty

2021 ◽  
Vol 9 (6) ◽  
Author(s):  
Dustin Rinehart ◽  
Ivy Nguyen ◽  
Michael Huo
Keyword(s):  
Venous Thromboembolism ◽  
Oral Anticoagulants ◽  
Professional Associations ◽  
Current Data ◽  
Ease Of Use ◽  
Current Status ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
The Past ◽  
Increased Risk

Background: A variety of local and systemic factors contribute to the increased risk of venous thromboembolism (VTE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA). The optimal regimen(s) for VTE prophylaxis are not conclusively defined at the present. This review is focused on the most current data on the outcomes of using various VTE prophylaxis following TKAs and THAs in the United State (U.S.) Methods: A review of the literature over the past 5 years was undertaken. We in particular focused on the data comparing the efficacy and the safety of different agents. Results: The commonly used VTE prophylaxis agents in the U.S. include: low-molecular-weight heparin, the new oral anticoagulants (factor Xa inhibitors), warfarin, and aspirin. Aspirin in particular has gained popularity over the past few years. This is principally due to several factors: less bleeding, equal efficacy, and the ease of use. Most surgeons use a “multi-modal” protocol including early mobilization, mechanical prophylaxis, and chemoprophylaxis. Conclusion: There is no conclusive evidence with regard to what agent(s) are the most efficacious and the safest in VTE prophylaxis following TKAs and THAs. There is however general agreement between the major guidelines from the professional associations of orthopedic surgery, and from the non-orthopedic disciplines. It is important to risk-stratify each patient, and to apply the most appropriate VTE prophylaxis.

scholarly journals Venous thromboembolism prophylaxis practice and its association with outcomes in Australia and New Zealand burns patients

2021 ◽  
Vol 9 ◽  
Author(s):  
Lincoln M Tracy ◽  
Peter A Cameron ◽  
Yvonne Singer ◽  
Arul Earnest ◽  
Fiona Wood ◽  
...  
Keyword(s):  
New Zealand ◽  
Venous Thromboembolism ◽  
Hospital Mortality ◽  
Best Practice ◽  
Burn Injury ◽  
Hospital Death ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Best Practice Guidelines ◽  
Increased Risk

Abstract Background Patients with burn injuries are considered to have an increased risk of venous thromboembolism (VTE). While untreated VTEs can be fatal, no studies have examined chemoprophylaxis effectiveness. This study aimed to quantify the variation in prevalence of VTE prophylaxis use in patients in Australian and New Zealand burns units and whether prophylaxis use is associated with in-hospital outcomes following burn injury. Methods Admission data for adult burns patients (aged ≥16 years) admitted between 1 July 2016 and 31 December 2018 were extracted from the Burns Registry of Australia and New Zealand. Mixed effects logistic regression modelling investigated whether VTE prophylaxis use was associated with the primary outcome of in-hospital mortality. Results There were 5066 admissions over the study period. Of these patients, 81% (n = 3799) with a valid response to the VTE prophylaxis data field received some form of VTE prophylaxis. Use of VTE prophylaxis ranged from 48.6% to 94.8% of patients between units. In-hospital death was recorded in <1% of patients (n = 33). After adjusting for confounders, receiving VTE prophylaxis was associated with a decrease in the adjusted odds of in-hospital mortality (adjusted odds ratio = 0.21; 95% CI, 0.07–0.63; p = 0.006). Conclusions Variation in the use of VTE prophylaxis was observed between the units, and prophylaxis use was associated with a decrease in the odds of mortality. These findings provide an opportunity to engage with units to further explore differences in prophylaxis use and develop future best practice guidelines.

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