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…
قراءة المزيد
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…
قراءة المزيد
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…
قراءة المزيد
DOACs
Ensure appropriate DOAC dosing
As a clinical pharmacist, you are in a key position to prevent direct oral anticoagulant (DOAC) dosing errors. Advocate for a pharmacist-to-dose protocol, recent evidence suggests this can reduce DOAC errors by almost half. Require an indication for DOAC orders and when documenting home DOACs to verify appropriate dosing. And include other key factors within your pr…
قراءة المزيد
HIT
DOACs are options for treating HIT
As a hospital pharmacist, you will get questions about using direct oral anticoagulants (DOACs) for heparin-induced thrombocytopenia (HIT) . We usually treat HIT with IV argatroban or sometimes IV bivalirudin or subcutaneous fondaparinux ( Arixtra ). Then we transition to warfarin ( Marevan ) once the platelet count recovers, usually 150,000/mm3 or higher. Now there&…
قراءة المزيد
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…
قراءة المزيد
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…
قراءة المزيد
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…
قراءة المزيد
Oncology
Using DOACs for venous thromboembolism due to cancer
As a clinical pharmacist, you'll continue to see a shift toward direct oral anticoagulants ( Eliquis , etc) for cancer-associated venous thromboembolism (VTE). We're used to seeing these patients on a low-molecular-weight heparin (LMWH), such as enoxaparin ( Clexane ) or warfarin ( Marevan ) as an alternative. But evidence with DOACs is stacking up for VTE du…
قراءة المزيد
Peripheral Artery Disease
Optimizing medications for peripheral artery disease
How to manage stable peripheral artery disease (PAD)? ㅡ Now that Xarelto (rivaroxaban) is approved for this use. Think of managing peripheral artery disease (PAD) as similar to coronary artery disease . Plaque buildup puts peripheral artery disease (PAD) patients at high risk of complications, such as cardiovascular (CV) events or limb amputation. And they may devel…
قراءة المزيد
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? …
قراءة المزيد
Stroke
Optimize anticoagulants to reduce stroke risk in atrial fibrillation patients
There will be buzz about optimizing anticoagulant use in atrial fibrillation patients based on the latest American Heart Association and Chest guidelines. Use these strategies to balance risks and benefits. Identify stroke risk factors in atrial fibrillation using the "CHA 2 DS 2 -VASc" score... Calculate CHA 2 DS 2 -VASc" score from MD+Calc (CH…
قراءة المزيد
Social Plugin