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J Hosp Med Nov;1 6 Innovative approaches to increase deep vein thrombosis prophylaxis rate resulting in a decrease in hospital-acquired deep vein thrombosis at a tertiary-care teaching hospital. J Hosp Med ;3 2 Medical admission order sets to improve deep vein thrombosis prophylaxis rates and other outcomes.
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Computerized order entry sets and intensive education improve the rate of prophylaxis for deep vein thrombophlebitis. Effect of a clinical pharmacy education program on improvement in the quantity and quality of venous thromboembolism prophylaxis for medically ill patients. J Manag Care Pharm ; Audit guided action can improve the compliance with thromboembolic prophylaxis prescribing to hospitalized, acutely ill older adults.
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Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention PEP trial. Lancet ; Venous thromboembolism prevention guidelines for medical inpatients: mind the implementation gap. J Hosp Med ,8 10 Risk-assessment models for predicting venous thromboembolism among hospitalized non-surgical patients: a systematic review.
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Laporte S, Mismetti P. Epidemiology of thrombotic risk factors: the difficulty in using clinical trials to develop a risk assessment model. The use of weighted and scored risk assessment models for venous thromboembolism. Thromb Haemost ; 6 Chest ; 3 Michota FA.
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High rates of venous thromboembolism prophylaxis did not increase the incidence of heparin-induced thrombocytopenia. A simple reminder system improves venous thromboembolism prophylaxis rates and reduces thrombotic events for hospitalized patients. Prevention of venous thromboembolism: best practice guidelines for Australia and New Zealand. Medication chart intervention improves inpatient thromboembolism prophylaxis. Improving the use of venous thromboembolism prophylaxis in an Australian teaching hospital. Venous thromboembolism is a common condition affecting 7. Incidence rates for venous thromboembolism are higher in men, African-Americans, and increase substantially with age.
It is critical to treat deep venous thrombosis at an early stage to avoid development of further complications, such as pulmonary embolism or recurrent deep venous thrombosis. The target audience for this guideline is all clinicians caring for patients who have been given a diagnosis of deep venous thrombosis or pulmonary embolism. The target patient population is patients receiving a diagnosis of pulmonary embolism or lower-extremity deep venous thrombosis. Low-molecular-weight heparin LMWH rather than unfractionated heparin should be used whenever possible for the initial inpatient treatment of deep venous thrombosis DVT.
Either unfractionated heparin or LMWH is appropriate for the initial treatment of pulmonary embolism. Consistent evidence demonstrates that LMWH is superior to unfractionated heparin for the initial treatment of DVT, particularly for reducing mortality and reducing the risk for major bleeding during initial therapy. Additional trials are needed to more rigorously examine the efficacy of LMWH for the initial treatment of pulmonary embolism, but systematic reviews of existing trials indicate that LMWH is at least as effective as unfractionated heparin for these patients as well.
In addition, trials of unfractionated heparin in pulmonary embolism show that many patients are subtherapeutic or supratherapeutic while receiving unfractionated heparin whereas LMWH is quickly and consistently therapeutic, an important consideration in the treatment of VTE.
Outpatient treatment of DVT, and possibly pulmonary embolism, with LMWH is safe and cost-effective for carefully selected patients, and should be considered if the required support services are in place. In trials that compared inpatient and outpatient treatment, the rates of recurrent DVT, major bleeding, and death during follow-up differed only slightly. These studies were conducted among highly selected groups of patients and in clinical systems with the required support services in place.
Several studies allowed a brief inpatient admission for stabilization of the patients before randomization to the outpatient group. While some studies enrolled patients with concomitant pulmonary embolism, the majority excluded such patients. Inclusion criteria were strict; most studies excluded patients with previous VTE, thrombophilic conditions, significant comorbid illnesses, pregnant patients, and those unlikely to adhere to outpatient therapy.
Therefore, this recommendation cannot be generalized. Compression stockings should be used routinely to prevent postthrombotic syndrome, beginning within 1 month of diagnosis of proximal DVT and continuing for a minimum of 1 year after diagnosis.