coagulation counseling

MARCH 01, 2008
Anna D. Garrett, PharmD, BCPS, CPP

Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.


National thought leaders and representatives from key organizations, including the American College of Chest Physicians, the American Public Health Association, and the Society of Hospital Medicine met several years ago to set and guide the direction of the Coalition to Prevent Deep Vein Thrombosis (DVT). A key outcome of this meeting was the decision to sponsor DVT Awareness Month, a campaign to bring DVT into the public eye on a national and local level. The inaugural DVT Awareness Month was March 2004, and March is now officially designated as DVT Awareness Month.

To date, >50 organizations have joined the Coalition to Prevent DVT in a united effort to raise DVT awareness among patients, health care professionals, policy makers, and public health leaders. According to the American Heart Association, up to 2 million Americans are affected annually by DVT. Of those who develop pulmonary embolism (PE), up to 200,000 will die each year. More Americans die annually from DVT/PE than from breast cancer and AIDS combined.

For more information, visit


The American Society of Clinical Oncology (ASCO) has developed guidelines for the use of anticoagulation in the prevention and treatment of venous thromboembolism (VTE) in patients with cancer. Based on a systematic review of randomized, controlled trials of primary and secondary VTE medical and surgical prophylaxis, VTE treatment, and the impact of anticoagulation on cancerpatient survival, the recommendations include:

  • VTE prophylaxis for all hospitalized cancer patients in the absence of bleeding risk factors or other contraindications
  • No routine prophylaxis of ambulatory cancer patients with anticoagulation unless they are receiving thalidomide or lenalidomide
  • Patients undergoing major surgery for malignancy should be considered for pharmacologic thromboprophylaxis
  • Use of low-molecular-weight heparin as the preferred agent for initial and continuing treatment of cancer patients with established VTE
  • Additional study of the impact of anticoagulants on patient survival

For full publication, visit


The FDA announced that Bayer Pharmaceuticals Corp. has agreed to a marketing suspension of Trasylol (aprotinin injection), a drug used to control bleeding during heart surgery. This announcement came after preliminary results from a Canadian study suggested an increased risk of death when the drug was used.

The FDA requested the suspension in the interest of patient safety, based on the serious nature of the outcomes suggested in the preliminary data. A thorough analysis of the data will be conducted to further assess the risks and benefits of Trasylol. The FDA is exploring ways for doctors to continue to have limited access to Trasylol for cases where the benefits outweigh the risks of use. Bayer will develop a plan to phase the drug out of the marketplace in a way that does not cause shortages of other drugs that are used for cardiac surgery.


The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is targeting anticoagulation safety in its 2008 list of Hospital National Patient Safety Goals. Institutions will be required to:

  • Develop a program that includes individualized anticoagulation management for each patient receiving anticoagulant therapy
  • Use unit-dose products and premixed infusions delivered via programmable infusion pumps
  • Use approved, disease-specific protocols for initiation and maintenance of anticoagulation therapy
  • Obtain baseline international normalized ratios for all patients receiving warfarin
  • Provide dietary services for warfarin patients
  • Provide adequate patient and family education
  • Evaluate safety practices related to anticoagulation

JCAHO established 4 deadlines:

  • April 1, 2008—Assignment of responsibility for program oversight and coordination of the development, testing, and implementation of the program
  • July 1, 2008—An implementation work plan, identifying adequate resources, assigned accountabilities, and a timeline for implementation
  • October 1, 2008—Pilot testing in at least 1 clinical unit
  • January 1, 2009—The process must be fully implemented

A resource for program development is available online at: