Pharmacy Student Monitoring of Direct Oral Anticoagulants.

Background: Best practice recommendations are lacking. Thus far, literature has described pharmacist-led DOAC monitoring.

Objective: The purpose of this study is to describe a DOAC monitoring program involving pharmacy students.

Overview of a pharmacist anticoagulation certificate program.

Background And Purpose: To describe the design of an ongoing anticoagulation certificate program and annual renewal update for pharmacists.

Educational Activity And Setting: Components of the anticoagulation certificate program include home study, pre- and posttest, live sessions, case discussions with evaluation and presentation, an implementation plan, and survey information (program evaluation and use in practice). Clinical reasoning skills were assessed through case work-up and evaluation prior to live presentation.

Pharmacological and clinical differences between low-molecular-weight heparins: implications for prescribing practice and therapeutic interchange.

Thanks to their predictable pharmacokinetics and ease of use, low-molecular-weight heparins (LMWHs) have established uses in the prevention and treatment of thrombotic diseases and as a replacement for unfractionated heparin (UFH). Although LMWHs as a class have similar antithrombotic effects, they comprise a diverse group of agents with distinct biochemical and pharmacological profiles. In light of the ongoing pressure to contain pharmacy costs, the diversity among the LMWHs and their benefits over UFH are important considerations in clinical practice.

Translating evidence-based guidelines into performance measures for venous thromboembolism and acute coronary syndrome.

Purpose: 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.

Summary: Efforts to develop evidence-based quality measures began in the mid to late 1990s and have led to the creation of various safe practices, indicators, standards, and quality measures and initiatives. The prevention and treatment of VTE and the management of ACS have been the focus of some of these initiatives.

The clinical challenge of bridging anticoagulation with low-molecular-weight heparin in patients with mechanical prosthetic heart valves: an evidence-based comparative review focusing on anticoagulation options in pregnant and nonpregnant patients.

Background: Recent labeling changes for enoxaparin, a low-molecular-weight heparin (LMWH), have prompted a reexamination of its role in patients with mechanical prosthetic heart valves (MPHVs). Healthcare providers are faced with the challenge of weighing favorable trial results with LMWHs and balancing their clinical experiences with these agents as a bridge to oral anticoagulation in patients with prosthetic heart valves. This review will provide evidence-based guidance on issues surrounding the use of LMWH that require bridging anticoagulant therapy in the setting of cardiac surgery (MPHVs), cardiovascular disease, and during temporary interruption of oral anticoagulants in patients requiring periprocedural bridging therapy.

The clinical effectiveness initiative: a pharmacy analysis to improve outcomes and costs of drug therapy.

Selecting the most appropriate therapeutic regimens is one of the most complex and critical aspects of pharmacy management today, but the process is fraught with biases. Clinical pharmacists must offer balanced and unbiased opinions concerning therapies that provide the best cost-benefit ratio for their organizations. This article describes the use of existing administrative databases to develop robust clinical resource utilization data, identify internal bias and barriers to efficient drug therapy selection, and devise medical management strategies that provide desirable clinical outcomes through cost-consequence analysis.

Anticoagulant prophylaxis in medical patients: an objective assessment.

Venous thromboembolism (VTE) is a clinically silent and potentially fatal disease that manifests as deep vein thrombosis (DVT) and pulmonary embolism. Venous thromboembolism remains a serious public health challenge, with an ever-increasing odds ratio of occurrence given the aging population in the United States. This article reviews the epidemiology of VTE; risk factor identification and stratification as a means of advancing awareness, prevention, and detection of VTE; and prophylaxis options and their outcomes, particularly administration of unfractionated heparin (UFH) 5000 U subcutaneously every 12 versus 8 hours in the at-risk medical patient population.

Challenges in variation and responsiveness of unfractionated heparin.

Unfractionated heparin (UFH) has been in clinical use for more than half a century. Despite its undoubted contribution to the treatment and prevention of thrombosis, heparin is significantly limited by its variable biochemical composition and unpredictable pharmacokinetics. The situation is compounded by the fact that methods for monitoring heparin do not necessarily reflect its therapeutic effect.

Evaluation of a novel point-of-care enoxaparin monitor with central laboratory anti-Xa levels.

Background: Measurement of enoxaparin's anticoagulant activity has been limited to specialized coagulation laboratories and has been impractical for areas needing rapid results, such as during coronary angioplasty. A new point-of-care device, Rapidpoint ENOX, was recently developed to measure clotting times with enoxaparin use.

Objectives: To correlate ENOX times with anti-Xa levels among patients receiving enoxaparin.

"Bridging" therapy with low molecular weight heparin in pregnant patients and patients with mechanical prosthetic heart valves.

A substantial body of published, peer-reviewed, trial and cohort study-based evidence, institutional data sets and expert clinical experience/opinion supports the safe and effective use of enoxaparin for anticoagulation management of non-pregnant patients with prosthetic mechanical heart valves. A comparable body of data and trial results exists, also supported by a significant and authoritative base of expert opinion, for enoxaparin-based VTE prevention and treatment of at-risk pregnant patients who do not have mechanical heart valves. In pregnant women with prosthetic mechanical heart valves, no recommendations on the use of LMWHs can be made until the availability of more data (Lovenox Injection (package insert).