Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol.

Patients with acute medical illnesses are at increased risk of venous thromboembolism (VTE), a significant cause of morbidity and mortality. Thromboprophylaxis is recommended in these patients but questions remain regarding the optimal duration of therapy. The aim of this study is to determine whether oral rivaroxaban is non-inferior to standard-duration (approximately 10 days) subcutaneous (s.

New oral anticoagulants.

The new oral anticoagulants may prove to be one of the most significant innovations in clinical practice in the past 60 years. Apixaban and rivaroxaban are specific inhibitors of Factor Xa while dabigatran inhibits Factor IIa. The predictable pharmacological profile of these new agents will allow physicians to use these drugs without the need for routine coagulation monitoring which is the mainstay of warfarin therapy.

Real-world practices to prevent venous thromboembolism with pharmacological prophylaxis in US orthopedic surgery patients: an analysis of an integrated healthcare database.

Major orthopedic surgery patients are at high risk of venous thromboembolism (VTE) in-hospital and post-discharge. This study assessed real-world inpatient and outpatient thromboprophylaxis practices following knee or hip arthroplasty. Patients from the Henry Ford Health System aged ≥18 years undergoing knee and hip arthroplasty (January 1997-June 2007) were identified using Current Procedural Terminology codes from administrative databases.

Appropriate VTE prophylaxis is associated with lower direct medical costs.

Purpose: To calculate and compare the direct medical costs of guideline-recommended prophylaxis with prophylaxis that does not fully adhere with guideline recommendations in a large, real-world population.

Methods: Discharge records were retrieved from the US Premier Perspective™ database (January 2003-December 2003) for patients aged≥40 years with a primary diagnosis of cancer, chronic heart failure, lung disease, or severe infectious disease who received some form of thromboprophylaxis. Univariate analysis and multivariate regression modeling were performed to compare direct medical costs between discharges who received appropriate prophylaxis (correct type, dose, and duration based on sixth edition American College of Chest Physicians [ACCP] recommendations) and partial prophylaxis (not in full accordance with ACCP recommendations).

New oral antithrombotic agents for the prevention of deep venous thrombosis and pulmonary embolism in orthopedic surgery.

As the population ages and medical care, along with a functional life style, continues to improve the health of this group, the number of joint replacement surgeries will continue to rise each year in the United States. This growing volume carries with it the risk of venous thromboembolism associated with joint replacement surgery. The American College of Chest Physicians and the American Academy of Orthopedic Surgery have provided guidelines for preventing this complication with the use of warfarin, low molecular weight heparins, pentasaccharides, and aspirin.

Improving venous thromboembolism performance: a comprehensive guide for physicians and hospitalists.

Venous thromboembolism (VTE) is a major potentially preventable cause of hospital deaths and is associated with a substantial clinical and economic burden in the United States. Despite the availability of effective thromboprophylactic agents and evidence-based management guidelines, VTE prophylaxis is commonly underused and inappropriately prescribed in real-world practice. Several US organizations have developed quality improvement initiatives to close the gap between guideline recommendations and clinical practice, and thus reduce VTE-associated morbidity and mortality.

Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators.

Background: Acutely ill, hospitalized medical patients are at risk of VTE. Despite guidelines for VTE prevention, prophylaxis use in these patients is still poor, possibly because of fear of bleeding risk. We used data from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) to assess in-hospital bleeding incidence and to identify risk factors at admission associated with in-hospital bleeding risk in acutely ill medical patients.

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.

The use of antithrombotic therapies in the prevention and treatment of arterial and venous thrombosis: a survey of current knowledge and practice supporting the need for clinical education.

Arterial and venous thrombosis are serious health threats. Patients with atrial fibrillation (AF), acute coronary syndromes (ACS), and venous thromboembolism (VTE) can reduce their risk of thrombosis through proper anticoagulation. Multiple evidence-based guidelines exist regarding the proper use of antithrombotic therapy, yet previous studies have shown the prevalence of inconsistent practices with respect to guideline recommendations.

F-18 FDG-PET/CT evaluation of patients with differentiated thyroid cancer with negative I-131 total body scan and high thyroglobulin level.

Purpose: The aim was to evaluate the incremental diagnostic rate of F-18 fluoro-fluorodeoxygulose positron emission tomography/computed tomography (F-18 FDG-PET/CT) in patients with negative I-131 whole body scans and high Tg levels. The secondary end points were correlations between F-18 FDG-PET/CT positive results and Tg levels and comparison between F-18 FDG-PET/CT accuracy in patients "on-therapy" with suppressed thyroid stimulating hormone (TSH) and those with high TSH levels.

Methods: We studied 52 patients who had undergone total thyroidectomy and remnant ablation; they had high Tg levels (average = 156 ng/mL; SD +/- 274) after 3 weeks of levothyroxine withdrawal and negative I-131 total body scans after therapeutic doses.

Hospital-based costs associated with venous thromboembolism prophylaxis regimens.

Clinically and economically, venous thromboembolic (VTE) disease represents a significant burden to the US healthcare system. This analysis compares the total direct medical costs associated with VTE prophylaxis with enoxaparin and unfractionated heparin (UFH). Hospital discharge and billing records were extracted from the Premier Perspective database (January 2002-December 2006).

Use of emerging oral anticoagulants in clinical practice: translating results from clinical trials to orthopedic and general surgical patient populations.

Objective: A review of clinical data from oral anticoagulant studies in orthopedic/general surgery and extrapolation to actual clinical practice.

Summary Background Data: In all surgical patients, there is a risk of postoperative venous thromboembolism (VTE). Parenteral unfractionated heparin, low-molecular-weight heparin, and fondaparinux are available for VTE prophylaxis.

Deep-vein thrombosis in malignancy: how long should patients be treated, and with what?

Cancer patients are at high-risk of venous thromboembolism (VTE). However, the optimal VTE prophylaxis and treatment options for this population are currently unclear. Surgical cancer patients have been shown to benefit from pharmacological VTE prophylaxis, with a number of trials suggesting that prophylaxis duration should extend beyond the traditional 7 day period.

Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery.

Objective: The aim of this study was to determine if there is a direct relationship between the duration of cardiopulmonary bypass (CPB time [CPBT]) and postoperative morbidity and mortality in patients undergoing cardiac surgery.

Design: Retrospective study.

Setting: Cardiac surgery unit, university hospital.

Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia.

Background: Subtle decreases in platelet count may impede timely recognition of heparin-induced thrombocytopenia (HIT), placing the patient at increased risk of thrombotic events.

Objective: A clinical decision support system (CDSS) was developed to alert physicians using computerized provider order entry when a patient with an active order for heparin experienced platelet count decreases consistent with HIT.

Methods: Comparisons for timeliness of HIT identification and treatment were evaluated for the year preceding and year following implementation of the CDSS in patients with laboratory confirmation of HIT.

Relationship of inferior vena cava filter usage in post-surgical patients by various surgical and medical subspecialists.

Venous thromboembolism is a common and often fatal problem in postsurgical patients. These patients are usually treated with either therapeutic anticoagulation or the placement of inferior vena cava (IVC) filters. Controversy surrounds the use of IVC filters, because no data exist proving survival benefit.