A recent retrospective study of 939 patients with venous thromboembolism randomly selected from 38 hospitals across the United States uncovered some areas for improvement in the care of patients with initial deep vein thrombosis (DVT). Of the study group, 68.6% completed the recommended length of therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) in the hospital, but only 50.6% had an international normalized ratio (INR) >2.0 for 48 hours prior to stopping the injectable drug. Treatment guidelines recommend maintaining the INR above 2.0 for at least 48 hours prior to stopping injectable therapy. Ten percent of patients included in the review were discharged on no anticoagulation with a mean duration of treatment of 10 days.
The authors concluded that lower than anticipated use of LMWH, insufficient bridging from UFH or LMWH to warfarin, and continuation of anticoagulation after hospitalization were all problems discovered in this cross-sectional study. They suggested that hospitals evaluate their adherence to international treatment guidelines and develop strategies to optimize antithrombotic therapy.
Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.
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