• Stuart T Haines, William E Dager, and Toby C Trujillo.
• University of Maryland School of Pharmacy, Baltimore, MD, USA. shaines@rx.maryland.edu
• Am J Health Syst Pharm. 2010 May 15;67(10 Suppl 6):S26-30.

PurposeTo illustrate clinical and management issues in the prevention of venous thromboembolism (VTE) in health systems.SummaryLack of evidence to guide the choice among available anticoagulants and the dosing, timing of initiation, and duration of therapy for VTE prevention in certain clinical situations can present challenges for clinicians. Patient characteristics such as the presence of obesity, epidural catheters, renal impairment, or heparin- induced thrombocytopenia complicate the decision-making process. The introduction of new anticoagulants may overcome some of the clinical challenges associated with VTE prophylaxis, but determining whether to add new agents to the formulary and restrict their use may pose management challenges. The safety, effectiveness, ease of use, and cost of new agents compared with older agents already on the formulary are primary considerations.ConclusionAn understanding of the clinical and management issues involved in preventing VTE is needed to improve the use of anticoagulants and reduce the incidence of VTE in health systems.

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