Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Feb 2010
ReviewWarfarin anticoagulation reversal: management of the asymptomatic and bleeding patient.
The management of patients with supra-therapeutic INR in a common clinical problem. The risk of bleeding is influenced by the intensity, variability and duration of anticoagulation, patient age, presence of co-morbidities and concomitant drug therapy. For the asymptomatic patient, warfarin discontinuation is all that is usually required but for individuals at high risk of bleeding and those with INR > 10, oral vitamin K administration is recommended. In the presence of major bleeding, treatment with intravenous vitamin K and prothrombin complex concentrate is the most effective therapy.
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J. Thromb. Thrombolysis · Feb 2010
Review Case ReportsImpact on patient care: patient case through the continuum of care.
Hospitalized patients are at increased risk of venous thromboembolism and the Joint Commission has initiated practice measures to improve the rates of preventable events. The Joint Commission also initiated the National Patient Safety Goals for medication prescribing and administration, of which, goal 03.05.01 is specifically aimed at anticoagulation therapy. These measures and goals are consistent with the American College of Chest Physicians' Consensus Guidelines on Antithrombotic and Thrombolytic Therapy. This narrative review uses a case-based approach that brings up practical clinical questions regarding these measures, goals and guidelines as they apply to a patient going through the continuum of care from the hospital to their home.
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J. Thromb. Thrombolysis · Feb 2010
ReviewWhat you should know about the 2008 American College of Chest Physicians evidence-based clinical practice guidelines (8th) on antithrombotic and thrombolytic therapy.
The American College of Chest Physicians published their first consensus conference guidelines on antithrombotic therapy in 1986 and has updated these guidelines approximately every 3 years as a supplement to the journal Chest. These guidelines are widely accepted as an authoritative source of information and considered by many to be the textbook for antithrombotic therapy. ⋯ Examples from the literature that support the evolution these guidelines will focus on changes that are most germane to the majority of attendees at the 10th National Conference on Anticoagulant Therapy and members of the AC Forum. The objective of this article is to help answer ten common clinical questions frequently faced by anticoagulation management services.
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J. Thromb. Thrombolysis · Feb 2010
Designing and implementing effective venous thromboembolism prevention protocols: lessons from collaborative efforts.
Hospital acquired venous thromboembolism (VTE) is a major source of morbidity and mortality, yet proven prevention measures are often underutilized. The lack of a validated VTE risk assessment model, difficulty integrating VTE risk assessment and prevention protocols into the routine process of care, and the lack of standardized metrics for VTE prophylaxis have all been barriers. Recently, a VTE risk assessment/prevention protocol has been validated, leading to portable strategies achieving breakthrough levels of adequate prophylaxis in a variety of inpatient settings. ⋯ A VTE prevention protocol is defined as a VTE risk assessment with no more than three levels of risk, tightly linked to recommended prophylaxis for each level. A balance between the need to provide protocol guidance and the need for efficiency and ease-of-use by the clinician must be maintained. The power of this protocol driven approach is bolstered by a quality improvement framework, multidisciplinary teams, ongoing monitoring of the process, and real time identification and mitigation of non-adherents via a technique that measures progress and prompts concurrent intervention, an approach we call "measure-vention."
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J. Thromb. Thrombolysis · Feb 2010
Development of national performance measures on the prevention and treatment of venous thromboembolism.
Venous thromboembolism (VTE) remains a significant public health problem in the United States, particularly for hospitalized patients. Approximately two-thirds of all VTE events are associated with recent hospitalization. ⋯ In addition to the organizational policy statement and 17 preferred practices, eight national performance measures addressing various aspects of VTE prevention and care have been endorsed. There is now a broad consensus on standardized measures of quality for the prevention and treatment of VTE, and a national commitment to collect and publicly report data on the quality of care for this important health problem.