Hematology and Oncology
Venous thromboembolism PROPHYLAXIS options
As a critical care pharmacist, it is crucial to identify patients who require venous thromboembolism (VTE) prophylaxis and those who should avoid it. According to the CHEST Guidelines, prophylaxis is recommended for acutely ill hospitalized medical patients at increased risk of thrombosis (hip replacement, obesity, cancer, advanced age, etc) , unless contraindicate…
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Side Effects
How to REVERSE bleeding due to Pradaxa or Xarelto
As a hospital pharmacist, the new oral anticoagulants are bringing up questions about how to reverse bleeding due to Pradaxa or Xarelto . Antidotes for Pradaxa (dabigatran) or Xarelto (rivaroxaban) are NOT available in many hospitals, like vitamin K for warfarin . But there are things you can do. Stopping the anticoagulant and w…
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Warfarin
When to Rely on WARFARIN Instead of a DOAC
As a clinical pharmacist, you will need to know when and why warfarin is sometimes preferred over a direct oral anticoagulant (DOAC). We’ve seen DOACs ( Eliquis , etc) take the lead for most uses, such as for atrial fibrillation or venous thromboembolism (VTE). But sometimes warfarin is still the go-to. Continue to rely on warfarin for patien…
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Tenecteplase
Do your part as a PHARMACIST in acute strokes
Clinicians will sort through new evidence looking for the best ways to bust clots in patients with acute ischemic stroke . Optimal stroke care is a big focus. The Joint Commission looks at whether patients get IV alteplase ( Activase ) appropriately and Medicare penalizes excess 30-day stroke readmissions. We know that one patient will have minimal or no disability …
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Tenecteplase
Acute stroke protocol update
The treatment of acute ischemic stroke will change due to new American Heart Association and American Stroke Association guidelines. Help update your hospital's screening and treatment protocols... Strive for faster turnaround times in stroke patients. For example, aim to rule out a hemorrhagic stroke with brain imaging within 20 minutes even though the qualit…
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Stroke
Clinical pharmacology of DOACs
Mechanism of action ㅡ Direct Oral Anticoagulants (DOACs) or Non-Vitamin K Antagonist Oral Anticoagulant (NOACs) are Direct Thrombin Inhibitors (e.g., Dabigatran) and Factor Xa Inhibitors (e.g. Rivaroxaban, Apixaban, Edoxaban) with prothrombinase activity, thus inhibiting the conversion of prothrombin to thrombin, see figure 1 . Thrombin c…
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Dual Antiplatelet Therapy
Limit bleeding risk in patients on triple antithrombotic therapy
How to manage patients on an anticoagulant (warfarin, etc) who also need antiplatelet medications ( aspirin , etc)? ㅡ Many patients end up on " triple antithrombotic therapy " such as warfarin for atrial fibrillation PLUS clopidogrel ( Plavix ) and aspirin after a stent. But bleeding risk is high. One in 50 patients will have a serious bleed in the first…
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Tenecteplase
Tenecteplase versus Alteplase for ischemic stroke
As a hospital pharmacist, you'll hear about more hospitals switching from alteplase ( Activase ) to tenecteplase ( TNKase ) to treat acute ischemic stroke. Tenecteplase is easier to give. It's a single IV push, due to its longer half-life rather than a bolus plus 1-hour infusion for alteplase. This may also speed up transfers for patients who need thrombecto…
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Surgery
How to manage direct oral anticoagulants (DOACs) around surgery?!
As a clinical pharmacist, you'll face questions about how to manage direct oral anticoagulants ( Eliquis , etc) around an elective procedure or surgery. Direct oral anticoagulants (DOACs) kick in and wear off faster than warfarin, so they need to be managed differently around procedures. Explain it's okay to continue DOACs for many low-bleeding-risk proced…
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Surgery
Management of minor bleeding from antithrombotics
Patients using an antithrombotic may be alarmed by "nuisance bleeding" OR nosebleeds, prolonged bleeding from a small cut, etc. This isn't typically serious or a reason to stop therapy. Share tips to prevent bleeding, such as using a saline spray to keep the nasal passages moist, an electric razor to avoid nicks while shaving and a soft toothbrush to pr…
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GIT and Liver
Safety of using anticoagulants in patients with cirrhosis
As a hospital pharmacist, you'll see anticoagulants used more often to treat thrombosis in patients with cirrhosis . We're used to thinking of these patients as having an increased bleeding risk due to impaired clotting factor production and thrombocytopenia. But don't consider them "auto-antico…
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Thromboembolism
Simple guide for venous thromboembolism (VTE) prophylaxis after surgery or hospitalization
When is venous thromboembolism (VTE) prophylaxis needed after hospitalization? Not very often . Stay alert for appropriate use. Hip or knee replacement patients Continue to recommend VTE prophylaxis for 14 to 35 days after knee or hip replacement. Recommend using a direct oral anticoagulant (DOAC), such as Eliquis (apixaban) or Xar…
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Hematology and Oncology
Note on treating venous thromboembolism (VTE)
Discover key insights into managing venous thromboembolism (VTE) with our concise guide. From preferred anticoagulants to treatment duration and recurrence management, we unravel critical considerations for optimal patient care. Which anticoagulant is preferred? How long should anticoagulation be used? When might a low-dose DOAC be considered long-term? …
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