VENOUS THROMOEMBOLISM

Venous thromboembolism (VTE) is an important medical problem that affects millions of patients each year. With appropriate prophylaxis, many of these thromboembolic events can be prevented. Although strong evidence supporting VTE prophylaxis spans several decades, several large American and global registries have documented very poor use of appropriate prophylaxis. Because of increasing regulatory requirements, hospitals nationwide are in the process of developing documentation of appropriate VTE prophylaxis programs for both surgical and medical patients. A wide range of clinicians must understand what constitutes appropriate VTE prophylaxis in various patient populations. With the existence of numerous pharmacologic agents, abundance of data from major clinical trials, and several nationally recognized clinical guidelines, compiling the needed reference material to make evidence-based decisions on appropriate VTE prophylaxis can be difficult for clinicians. Therefore, we provide a bibliography of key articles and guidelines related to the prevention of VTE in various patient groups. We hope this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients who may be at risk for VTE.
INTRODUCTION
Venous thromboembolism (VTE), which encompasses both deep vein thrombosis (DVT) and pulmonary embolism, is a significant health care problem, causing considerable morbidity, mortality, and resource utilization.[1] Every year in the United States, there are more than 1 million DVT events and more than 100,000 deaths from pulmonary embolism. These events occur in a wide range of patients in both surgical and medical populations. Among patients discharged from U.S. hospitals, VTE was the second leading cause of medical complications and prolonged length of stay, and third leading cause of preventable mortality and excessive hospital charges.[2] Clinicians must realize that many thromboembolic events can be prevented with appropriate VTE prophylaxis. Despite more than 30 years of demonstrated effectiveness and safety, VTE prophylaxis is substantially underutilized. This underutilization has led to the recent involvement of government and other regulatory agencies in an attempt to improve VTE prophylaxis in U.S. hospitals.
The Cardiology Practice and Research Network (PRN) of the American College of Clinical Pharmacy has taken the initiative to compile lists of key articles and guidelines in major focus areas of cardiology. From 2004-2006, five collections of annotative bibliographies were published on the topics of acute coronary syndromes, arrhythmias, hypertension, systolic heart failure, and dyslipidemias.[3-7] These documents are being updated and published in Pharmacotherapy.[8] Since the prevention of VTE is not only a cardiology issue, the Cardiology PRN joined with the Internal Medicine PRN and the Ambulatory Care PRN to compile this document that focuses on key articles and guidelines in the prevention of VTE. We collected guidelines and significant articles published in the area of VTE prevention and provide a summary of the results of the clinical trials, as well as clinical insights on the implications for clinical practice and research. This document will serve as an excellent review and resource for pharmacists, physicians, nurses, residents, and students, especially in this time of increased attention on VTE prevention.

Can Erythropoiesis-Stimulating Agents Increase Mortality in Patients With Cancer?

Bohlius J, Schmidlin K, Brillant C, et al
Lancet. 2009;373:1532-1542
SUMMARY
To determine the role of erythropoiesis-stimulating drugs, such as epoetin on patients with cancer, the study authors conducted a meta-analysis of 53 randomized trials involving almost 14,000 patients. The study included all common tumor types and patients of varying ages with varying degrees of anemia. The combined results showed that these drugs caused a 17% increase in overall mortality (P = .003) and a reduced survival (P = .046).The results appeared to be unchanged by different types of cancer therapy.
VIEWPOINT
One of the strengths of this study is that it was carried out on individual patient data from each trial, rather than on published results. Clinicians have used these compounds because they reduce patient fatigue and lesson the need for transfusions. However, this carefully conducted trial demonstrated that these improvements in quality of life must be balanced against the increased mortality and lower life expectancy.