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Hospitalists Are Frontline Providers in Treating Venous Thromboembolism

The Hospitalist. 2015 March;2015(03):

Dr. Lindsey, a member of Team Hospitalist, cautions that e-measures have the potential to increase unwanted events by overutilization of pharmacologic VTE prophylaxis and associated hemorrhagic events.

“We have to continue to make sure that our practice of medicine remains based in evidence and not succumb to the pull of getting a check-box ticked,” she warns.

VTE remains a significant problem in hospitalized patients today. Hospitalists should consider the pros and cons of using newer treatment methods over traditional agents. Efforts are under way to improve VTE prophylaxis by standardizing best practice and moving from traditional chart abstracting to using e-measures for performance reporting.


Karen Appold is a freelance medical writer in Pennsylvania.

Getting the Upper Hand

Getting involved in your hospital’s venous thromboembolism (VTE) task force is a great opportunity to have your voice heard and become involved in the implementation of change in your hospital’s VTE management process. It also is a forum in which you could learn more about VTE, including appropriate prophylaxis methods for various patient populations.

Some other VTE resources:

  • The American College of Chest Physicians offers evidence-based practice guidelines on the management and prevention of VTE.
  • SHM is airing a seven-part webinar series on anticoagulation, which is free to members via the Learning/Education portal. By participating in all of the sessions, members earn 6.5 AMA PRA category 1 credit hours. “The knowledge imparted will help me to improve my practice of hospital medicine and treatment of patients requiring anticoagulants, which is the majority of our patients,” Dr. Lindsey says.

—Karen Appold

Bringing Awareness to VTE

Thromboembolisms (VTEs) are the most common cause of preventable death in the hospitalized patient. Given the adverse outcomes and economic burden associated with VTEs, it is truly a public health concern. As Dr. Kanikkannan suggests, “Why not use the month of March—VTE awareness month—as an opportunity to educate patients about healthy lifestyle practices to prevent VTE?

“Patients can learn to identify their risk factors and become aware of symptoms that may be a cause for concern, prompting them to seek medical attention,” she says.

“It might be helpful for hospitals to arrange review sessions for VTE prophylaxis for providers and staff.” —Dr. Suehler

Hospitalists could also organize or participate in community health fairs—a great venue to spread the word about VTE and create awareness among the public. Because hospitalists frequently sit on VTE task forces in hospitals and take a lead role in implementing VTE prophylaxis efforts, they are in a prime position to implement a hospital campaign during VTE awareness month.

Keeping staff abreast of advancements is also advisable.

“It might be helpful for hospitals to arrange review sessions for VTE prophylaxis for providers and staff,” says Klaus Suehler, MD, FHM, hospitalist at Mercy Hospital Allina Health in Coon Rapids, Minn., who believes that creating awareness makes a 0% failure rate on VTE prophylaxis achievable.

—Karen Appold

References

  1. Centers for Disease Control and Prevention. Public Health Grand Rounds. Preventing venous thromboembolism. January 15, 2013. Available at: https://www.cdc.gov/cdcgrandrounds/archives/2013/january2013.htm. Accessed February 12, 2015.
  2. Dobesh PP. Economic burden of venous thromboembolism in hospitalized patients. Pharmacotherapy. 2009;29(8):943-953.
  3. Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Portman RJ. Apixaban or enoxaparin for thromboprophylaxis after knee replacement. N Engl J Med. 2009;361(6):594-604.
  4. Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Hornick P; ADVANCE-2 Investigators. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet. 2010;375(9717):807-815.
  5. Lassen MR, Gallus A, Raskob GE, Pineo G, Chen D, Ramirez LM; ADVANCE-3 Investigators. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med. 2010;363(26):2487-2498.
  6. Cohen AT, Spiro TE, Büller HR, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013;368(6):513-523.
  7. Goldhaber SZ, Leizorovicz A, Kakkar AK, et al. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med. 2011;365(23):2167-2177.
  8. Gonsalves WI, Pruthi RK, Patnaik MM. The new oral anticoagulants in clinical practice. Mayo Clin Proc. 2013;88(5):495-511.
  9. Holster IL, Valkoff VE, Kuipers EJ, Tjwa ET. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology. 2013;145(1):105-112.
  10. Drescher FS, Sirovich BE, Lee A, Morrison DH, Chiang WH, Larson RJ. Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: a systematic review and meta-analysis. J Hosp Med. 2014;9(9):579-585.
  11. Bullock-Palmer RP, Weiss S, Hyman C. Innovative approaches to increase deep vein thrombosis prophylaxis rate resulting in a decrease in hospital-acquired deep vein thrombosis at a tertiary-care teaching hospital. J Hosp Med. 2008;3(2):148-155.