American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Jun 2007
Review Case ReportsAssessing, preventing, and treating venous thromboembolism: evidence-based approaches.
The long-term complications of deep vein thrombosis (DVT), assessment of risk for venous thromboembolism (VTE) in medical and surgical patients, recommendations in evidence-based guidelines for VTE prophylaxis in surgical and medical patients and the treatment of VTE, and a new alternative for VTE prophylaxis and treatment are discussed. ⋯ Efforts to assess VTE risk and apply evidence-based guidelines for VTE prophylaxis and treatment in medical patients as well as surgical patients can improve patient care and outcomes. Findings from recent clinical research provide clinicians with clarification about the optimal prophylactic and treatment strategies, and future guidelines will reflect these findings.
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Am J Health Syst Pharm · Jun 2007
Comparative StudyValsartan versus lisinopril or extended-release metoprolol in preventing cardiovascular and renal events in patients with hypertension.
The objective of this study was to compare cardiovascular and renal events in patients with hypertension receiving the angiotensin II-receptor blocker valsartan versus those receiving the angiotensin-converting-enzyme lisinopril or the beta-blocker metoprolol succinate in an extended-release formulation. ⋯ Results of this observational study suggest that the use of valsartan may reduce the risk of major cardiovascular and renal events compared with extended-release metoprolol.
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Am J Health Syst Pharm · Jun 2007
Case ReportsManaging acute coronary syndrome: evidence-based approaches.
To describe data and insights from a national quality improvement initiative known as Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines (CRUSADE), for managing non-ST-segment elevation acute coronary syndrome (ACS), as well as the findings and implications of Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY), a study of bivalirudin with or without a glycoprotein (GP) IIb/IIIa inhibitor in patients with non-ST-segment elevation ACS who were undergoing an invasive intervention, and the results of two recent studies of clopidogrel in patients with ST-segment elevation myocardial infarction (MI) that are not reflected in current ACC/AHA guidelines for managing ST-segment elevation MI. ⋯ Evidence-based guidelines provide recommendations for the management of ACS, but the pace of clinical research is rapid and current guidelines do not reflect the latest research findings. Pharmacists need to stay abreast of new developments and ensure that clinical practice reflects these developments.
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Am J Health Syst Pharm · Jun 2007
Translating evidence-based guidelines into performance measures for venous thromboembolism and acute coronary syndrome.
The evolution of evidence-based quality measures in healthcare, specific performance measures that have been developed by various groups for the prevention and treatment of venous thromboembolism (VTE), the objectives and potential benefits of a national quality improvement initiative designed to improve the care of high-risk patients with acute coronary syndrome (ACS), the reporting of performance data to the public to guide consumer choice, and the recent growth in pay-for-performance programs are described. ⋯ The various initiatives under way using evidence-based performance measures to evaluate quality of care for VTE and ACS have the potential to improve patient outcomes.
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Data collected from the Food and Drug Administration (FDA) under the Freedom of Information Act are presented to help clinicians understand the data prompting the black-box warning for droperidol and to make educated decisions regarding the use of droperidol and alternative agents. ⋯ Studies show that there is a dose-dependent increase in the rate of adverse cardiovascular events when droperidol is used either alone or in combination with other medications that cause Q-T interval prolongation. At this time, there does not appear to be significant evidence to suggest that serotonin type 3-receptor (5-HT(3)) antagonists are safer than droperidol with regard to Q-T interval prolongation. More studies are needed to determine the safety and efficacy of droperidol when used in doses of 0.625-1.25 mg compared with the 5-HT(3) antagonists.