Vital VTE Interventions

Pills

Venous thromboembolism (VTE) affects more than 2 million Americans every year.1 Pulmonary embolism (PE) is one of the most common preventable causes of in-hospital deaths in the United States. Clinical manifestations of PE may be the first indication the patient has a VTE, and fatal PEs occur in at least 75% of hospitalized medical patients. More than 300,000 patients die from PE each year—an estimated incidence of 10%. This makes VTE prevention a top patient-safety goal in hospitals.2,3

Thromboprophylaxis can be accomplished with unfractionated heparin (UFH), low-molecular-weight heparin (LMWH; e.g., enoxaparin, dalteparin, tinzaparin) or heparinoid, or a selective factor Xa inhibitor (e.g., fondaparinux).4 For long-term treatment, oral warfarin is often used. Doses and duration of prophylaxis and treatment regimens vary.

Thromboprophylaxis can prevent significant morbidity and PE and decrease resource consumption and long-term clinical and economic sequelae.

Current guidelines should be reviewed for specific recommendations. Two current guidelines are the American College of Chest Physicians (ACCP) Seventh Conference on the Prevention of VTE and the American Society of Clinical Oncology (ASCO) Guideline for VTE prophylaxis and treatment in oncology patients. Although guidelines are available, thromboprophylaxis continues to baffle many healthcare providers. There are many advantages to thromboprophylaxis including the prevention of significant morbidity, prevention of PE, decreases in resource consumption, and decreases in the long-term clinical and economic sequelae.

The ACCP notes that most surgical patients will require thromboprophylaxis. Contraindications need to be evaluated prior to antithrombotic/anticoagulant use. Additionally, all trauma patients with at least one VTE risk factor should receive thromboprophylaxis. Acutely ill patients hospitalized with congestive heart failure or severe respiratory distress or who are confined to bed and have one or more additional risk factors, should receive VTE prophylaxis. Additionally, most patients upon admission to an intensive-care unit should be assessed for VTE risk and receive thromboprophylaxis as required.

New Indications,Dosage Forms

Aripiprazole (Abilify) has been approved by the Food and Drug Administration (FDA) for a new indication, for use as adjunctive treatment to antidepressant therapy in adults with major depressive disorder.

Brimonidine tartrate 0.2%/timolol maleate 0.5% ophthalmic solution (Combigan) has been FDA-approved for lowering intraocular pressure in patients with ocular hypertension or glaucoma. It is dosed twice daily.

Carbidopa, levodopa, entacapone (Stalevo) combination tablets for treating Parkinson’s disease, were FDA approved in a new strength of 200 mg which can be dosed up to six times daily. Other available tablet strengths are 50, 100, and 150 mg. The strength is based on the levodopa component.

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