coagulation counseling

Pharmacy Times
Volume 0

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


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

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

For more information, visit


The American Society of Clinical Oncology (ASCO) has developedguidelines for the use of anticoagulation in the preventionand treatment of venous thromboembolism (VTE) in patients withcancer. Based on a systematic review of randomized, controlledtrials of primary and secondary VTE medical and surgical prophylaxis,VTE treatment, and the impact of anticoagulation on cancerpatientsurvival, 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 unlessthey are receiving thalidomide or lenalidomide
  • Patients undergoing major surgery for malignancy should be considered for pharmacologicthromboprophylaxis
  • Use of low-molecular-weight heparin as the preferred agent for initial and continuingtreatment 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 marketingsuspension of Trasylol (aprotinin injection), a drug used to control bleeding duringheart surgery. This announcement came after preliminary results from a Canadianstudy suggested an increased risk of death when the drug was used.

The FDA requested the suspension in the interest of patient safety, based on theserious nature of the outcomes suggested in the preliminary data. A thorough analysisof 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 Trasylolfor cases where the benefits outweigh the risks of use. Bayer will develop a plan tophase the drug out of the marketplace in a way that does not cause shortages ofother drugs that are used for cardiac surgery.


The Joint Commission on Accreditationof Healthcare Organizations(JCAHO) is targeting anticoagulationsafety in its 2008 list ofHospital National Patient SafetyGoals. Institutions will be required to:

  • Develop a program that includesindividualized anticoagulation managementfor each patient receivinganticoagulant therapy
  • Use unit-dose products and premixedinfusions delivered via programmableinfusion pumps
  • Use approved, disease-specificprotocols for initiation and maintenanceof anticoagulation therapy
  • Obtain baseline international normalizedratios for all patientsreceiving warfarin
  • Provide dietary services for warfarinpatients
  • Provide adequate patient and familyeducation
  • Evaluate safety practices relatedto anticoagulation

JCAHO established 4 deadlines:

  • April 1, 2008—Assignment of responsibilityfor program oversightand coordination of the development,testing, and implementationof the program
  • July 1, 2008—An implementationwork plan, identifying adequate resources,assigned accountabilities,and a timeline for implementation
  • October 1, 2008—Pilot testing inat least 1 clinical unit
  • January 1, 2009—The processmust be fully implemented

A resource for program developmentis available online at:

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