Dr. Benge is a clinical pharmacy specialist in cardiology at the VA Tennessee Valley Healthcare System in Nashville. Dr. Yost is a clinical pharmacy specialist in critical care at the Saint Thomas Rutherford Hospital in Murfreesboro, Tennessee. Dr. Benge is also a clinical assistant professor and Dr. Yost is also a clinical assistant professor, both at the University of Tennessee College of Pharmacy in Memphis.
Overall, about one-third of patients did not receive potentially indicated pharmacologic thromboprophylaxis on the medical wards. Use of pharmacologic thromboprophylaxis in medical CCU patients was robust (80%). Doses and dosing intervals were appropriate for > 90% of patients, and therapy clearly was started early and continued for much of the at-risk period, as the VTE protected time period exceeded 80%. Although computerized tools were limited, the authors feel their modest pharmacologic thromboprophylaxis rate is related to the facility’s teaching hospital affiliation or the provider mix, because TVHS is one of the largest VA cardiology centers in the U.S.7,8,13
As it was challenging and time consuming to locate eligible subjects, it may also prove difficult for the admitting physician to have the same luxury of time to look for specific at-risk diagnoses in the medical record and evaluate for exclusions to therapy. If electronic alerts and reminder tools were included in clinical pharmacy inpatient templates, the authors believe the frequency of pharmacologic thromboprophylaxis would further improve in the facility. Also, the authors encourage VHA researchers to further evaluate VTE prophylaxis RAM, the role of daily electronic reminders, and tools to calculate VTE and bleeding risk.
Acknowledgements The authors are grateful to James Minnis, PharmD, BCPS, and April Ungar, PharmD, BCPS, for their contributions to the study design. This material is the result of work supported with resources and the use of facilities at the VA Tennessee Valley Healthcare System.
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
