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HEMATOLOGY

Venous Thromboembolism Prophylaxis Conversion in Nonsurgical Inpatients

Clinical Assistant Professor, Department of Administrative and Clinical Sciences, College of Pharmacy, University of Oklahoma, Tulsa, OK

Edward B Hudson, MHA DPh

Pharmacy Clinical Coordinator, Pharmacy Department, Hillcrest Medical Center, Tulsa

Reprints: Douglas N Carroll PharmD, Department of Administrative and Clinical Sciences, College of Pharmacy, University of Oklahoma, 4502 E. 41st St., Suite 1H03, Tulsa, OK 74135-2512, FAX 918/660-3580, doug-carroll{at}ouhsc.edu

OBJECTIVE: To provide venous thromboembolism (VTE) prophylaxis according to national consensus guidelines while minimizing associated medication costs.

METHODS: Patients admitted to our institution who were receiving VTE prophylaxis with the low-molecular-weight heparin (LMWH) enoxaparin were identified and evaluated for potential conversion to low-dose unfractionated heparin (LDUH). Patients admitted for general medical conditions were targeted for a potential conversion. Factors that excluded patients from conversion were any surgical intervention or evidence of bleeding. For all eligible patients, the treating physician was contacted through written recommendations in an effort to achieve conversion to an LDUH regimen.

RESULTS: Throughout a 10-month period, 463 patients were identified as receiving enoxaparin for VTE prophylaxis. Of these, 112 (24%) were candidates for an LDUH regimen. A total of 88 pharmacy recommendations were provided, of which 59 (67%) were accepted. This conversion program resulted in the avoidance of 250 days of enoxaparin prophylaxis and $8495 of associated medication costs.

CONCLUSIONS: Clinical pharmacy programs directed at converting patients from a more costly LMWH regimen for VTE prophylaxis to an LDUH regimen can significantly reduce medication costs while adhering to consensus guidelines.

Key Words: heparin, low-molecular-weight heparin, prophylaxis, venous thromboembolism

Published Online, July 2, 2003. www.theannals.com, DOI 10.1345/aph.1C509

This article has been cited by other articles:

				E. Burleigh, C. Wang, D. Foster, S. Heller, D. Dunn, K. Safavi, B. Griffin, and J. Smith Thromboprophylaxis in medically ill patients at risk for venous thromboembolism. Am. J. Health Syst. Pharm., October 15, 2006; 63(20 Suppl 6): S23 - S29. [Abstract] [Full Text] [PDF]

				J. Fanikos and K. Tsilimingras Comment: venous thromboembolism prophylaxis conversion in nonsurgical inpatients Ann. Pharmacother., December 1, 2003; 37(12): 1914 - 1915. [Full Text] [PDF]

				J. B Groce Comment: venous thromboembolism prophylaxis conversion in nonsurgical inpatients Ann. Pharmacother., December 1, 2003; 37(12): 1915 - 1916. [Full Text] [PDF]

				D. N Carroll and E. B Hudson Authors' Reply Ann. Pharmacother., December 1, 2003; 37(12): 1916 - 1917. [Full Text] [PDF]