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Venous Thromboembolism: Optimizing Clinical Outcomes for the Elderly

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Abstract:

Objectives: To present an overview of venous thromboembolism (VTE) and its impact on society, especially on the elderly. To present details from an epidemiology study on VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE).

Data Sources: Published medical journal articles.

Conclusions: VTEs are responsible for more than 300,000 hospital admissions each year in the United States. In the geriatric population, PE and DVT are especially deadly: PE accounts for a 39% mortality rate each year, DVT for a 21% annual mortality rate.

Objectives: To define evidence-based pharmaceutical care. To present a historical overview of the American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic Therapy. To understand the various grades of recommendations in the ACCP Guideline criteria.

Data Sources: Published medical journal articles. Information from the ACCP Web site.

Conclusions: Evidence-based pharmaceutical care has emerged as a means of evaluating the medical literature to determine the approaches for therapeutic options in the prevention and treatment of venous thromboembolism (VTE), deep-vein thrombosis (DVT), and pulmonary embolism (PE). By applying the principles of evidence-based pharmaceutical care, consultant pharmacists can help their patients and others involved in their care understand the benefits and risks of various therapies and make treatment choices that are both sound and of value.

Objective: To provide an update concerning the leading agents used in the prophylaxis and treatment of venous thromboembolism (VTE).

Data Sources: Published studies on VTE and the various therapeutic agents currently and soon to be available.

Conclusion: Newer anticoagulants such as low-molecular-weight heparin, fondaparinux, and ximelagatran overcome some of the disadvantages of older therapeutic options. In some cases, the newer options are also more cost-effective.

Objectives: To provide an update concerning prophylaxis therapy in venous thromboembolism (VTE) in the elderly population, with particular emphasis on the use of fondaparinux and enoxaparin. To foster greater understanding of the role pharmacists play in medication management for the prevention of VTE after orthopedic surgery, following cancer surgery, in internal medicine, and patients in intensive care units (ICUs).

Data Sources: Published evidence-based studies on comparative prophylaxis and the transcript from Dr. Bruce Davidson's satellite symposium-presented at Geriatric ′04, ASCP's 26th Midyear Conference and Exhibition held in Scottsdale, Arizona.

Conclusion: Evidence-based studies show that prolonged prophylaxis of fondaparinux (2.5 mg subcutaneously daily for a month) for orthopedic fractures is recommended for the elderly patient in reducing the risk of VTE. Fondaparinux prophylaxis, while in the hospital and for one month after discharge, costs no more than enoxaparin. In patients undergoing cancer surgery of the abdomen or pelvis, prolonged prophylaxis of enoxaparin (40 mg subcutaneously daily for a month) has been demonstrated to significantly reduce the risk of VTE. For medical and intensive care patients, prophylaxis at the time of hospitalized illness is superior to no prophylaxis at all.

Objectives: To present an overview of the role a consultant pharmacist plays in venous thromboembolism (VTE). To present various interventions and communication techniques for the consultant pharmacist.

Data Sources: Published medical journal articles and consensus guidelines.

Conclusions: VTEs are responsible for more than 300,000 hospital admissions each year in the United States. In the geriatric population, pulmonary embolism (PE) and deep vein thrombosis (DVT) are especially deadly. The consultant pharmacist needs to be knowledgeable about these disorders; perform drug regimen reviews; manage risk; establish cost-control measures; monitor adverse drug reactions (ADRs); and communicate with the patient, other health care professionals, and nursing home management on preventive measures and treatment options for VTE.

Keywords: Adverse drug reaction monitoring; American College of Chest Physicians (ACCP); Anticoagulation; Antifactors; Antithrombin; Cancer; Coagulation; Communication; Cost control; Deep vein thrombosis; Drug regimen review; Enoxaparin; Evidence-based pharmaceutical care; Factors II, IIa, V, VIII, IXa, X, Xa and XIIa; Fondaparinux; Heparin; Heparin-induced thrombocytopenia; Hip; Knee replacement; Low-molecular-weight heparin; Melagatran; Pentasaccharide; Prothrombin; Pulmonary embolism; Risk management; Thrombin; Thrombocytopenia; Thrombosis; Unfractionated heparin; Venous thromboembolism; Ximelagatran; and knee replacement; joint

Document Type: Research Article

DOI: http://dx.doi.org/10.4140/TCP.sB.2004.1

Publication date: January 1, 2004

More about this publication?
  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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