HM12’s Clinical Pearls

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DVT Prophylaxis: Don’t Forget the Pediatric Patients

Most would agree that hospitalists have seen more thrombosis in children over the past decade, and although it isn’t known why, it is likely due to multifactorial causes, said Leslie Raffini, MD, MSCE, director of the Hemostasis and Thrombosis Center at Children’s Hospital of Philadelphia.

Central venous catheters remain a significant risk factor for venous thromboembolism (VTE), and our knowledge of inherited risk factors has expanded in recent years. While it is likely that inherited risk factors increase the risk of thrombosis in children, the question of testing has engendered debate, due in large part to the lack of clear benefit of that information in the majority of situations.

“The decision to test should be made on an individual basis, after counseling,” said Dr. Raffini. “Results should be interpreted by an experienced physician with adolescent females most likely to benefit from the testing. There are no recommendations for what to do with pediatric patients” despite the fact that this is an important cause of morbidity in high-risk patients.

Dr. Raffini described efforts at Children’s Hospital of Philadelphia that led to a VTE prophylaxis guideline. Successful implementation of the guideline required significant multidisciplinary collaboration, and an analysis of outcomes is under way.

KEY TAKEAWAYS

Mark Shen, MD, SFHM, FAAP

  • The decision to test for inherited risk factors should be individualized.
  • Adolescent females are most likely to benefit from testing for inherited risk factors.
  • Implementation of guidelines requires intentional multidisciplinary collaboration.

A program that is structured in such a way as to hire or retain experienced hospitalists is likely to have a higher cost savings than one that doesn’t.

—Mark Shen, MD, SFHM, FAAP, medical director of hospital medicine, assistant professor of pediatrics, Dell Children’s Medical Center, Austin, Texas

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Updates from the 9th ACCP Antithrombotic Therapy Guidelines

The evidence-based, rapid-fire presentation by Catherine Curley, MD, of MetroHealth Medical Center in Cleveland on the brand-new antithrombotic therapy from the ACCP took attendees through key aspects of the new guidelines. Dr. Curley used the more controversial topics as examples: treatment of submassive PE, use of catheter-directed thrombolysis in patients with acute DVT, recommended VTE prophylaxis. She even threw in some anatomy lessons for clinicians.

KEY TAKEAWAYS

Larry W. Holder, MD, FACP, FHM

  • Major innovations in the methodology in the AT9: Focusing on the absolute effects to allow the provider to weigh the benefits and risks of therapy easily; rigorous conflict-of-interest reviews of the editors; re-analysis of many older studies; and simplified recommendations with emphasis on summary-of-finding tables as opposed to texts.
  • A strong focus on patient-centered outcomes recommends specifically focusing on patients’ preferences.

A program that is structured in such a way as to hire or retain experienced hospitalists is likely to have a higher cost savings than one that doesn’t.

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