Recent Trends in Clinical Outcomes and Resource Utilization for Pulmonary Embolism in the United States. Findings From the Nationwide Inpatient Sample
|
|
- Loraine Wade
- 6 years ago
- Views:
Transcription
1 CHEST Recent Trends in Clinical Outcomes and Resource Utilization for Pulmonary Embolism in the United States Findings From the Nationwide Inpatient Sample Brian Park, MD; Louis Messina, MD; Phong Dargon, MD; Wei Huang, MS; Rocco Ciocca, MD; and Frederick A. Anderson, PhD Original Research PULMONARY EMBOLISM Background: Pulmonary embolism (PE) has been cited as the most common preventable cause of death in hospitalized patients. The objectives of this study were to determine recent trends in clinical outcomes and resource utilization for hospitalized patients with a clinically recognized episode of acute PE. Methods: Patients with primary or secondary PE who had been discharged from US acute care hospitals were identified from the Nationwide Inpatient Sample during the 8-year period between 1998 and The major clinical outcomes assessed included hospital mortality and length of hospitalization. To assess resource utilization for the treatment of PE, average hospital charges for these admissions were assessed, normalized to 2005 US dollars, and adjusted to reflect the US consumer price index. Results: Between 1998 and 2005, the number of patients with primary or secondary PE on discharge from the hospital increased from 126,546 to 229,637; hospital case fatality rates for these patients decreased from 12.3 to 8.2% (p < 0.001); length of hospital stay decreased from 9.4 days to 8.6 days (p < 0.001); and total hospital charges increased from $25,293 to $43,740 (p < 0.001). Conclusions: Between 1998 and 2005, significant improvements were observed in outcomes for patients hospitalized for clinically recognized PE, including decreases in mortality and length of hospital stay. Charges for this hospital care increased during this time period. (CHEST 2009; 136: ) Abbreviations: ICD-9 International Classification of Diseases, ninth revision; NIS Nationwide Inpatient Sample; PE pulmonary embolism; VTE venous thromboembolism Pulmonary embolism (PE) is a leading cause of mortality and morbidity in hospitalized patients in the United States. Between 5% and 10% of hospital deaths are attributable to PE, 1 3 leading to an estimated 100,000 to 200,000 deaths annually in Manuscript received September 18, 2008; revision accepted May 5, Affiliations: From the Department of Surgery (Drs. Park, Messina, and Dargon), Division of Vascular Surgery, and Center for Outcomes Research (Ms. Huang and Dr. Anderson), University of Massachusetts Medical School, Worcester, MA; and the Department of Surgery (Dr. Ciocca), Division of Vascular Surgery, Caritas St. Elizabeth s Medical Center, Tufts University School of Medicine, Boston, MA. This work was presented at the annual meeting of the Society for Clinical Vascular Surgery, Las Vegas, NV, March 5 8, Funding/Support: This work was funded by the Center for Outcomes Research, Department of Surgery, University of the United States from PE. 4 6 Because prophylaxis is clinically effective and cost-effective, 7 9 PE is the most common preventable cause of death in hospitalized patients. 7 Contemporary studies estimate that annual healthcare expenditures related to venous thromboembolism Massachusetts Medical School, Worcester, MA. No commercial sponsorship or other external financial support was used in the conduct of this work. Correspondence to: Frederick A. Anderson, PhD, University of Massachusetts Medical School, Center for Outcomes Research, 365 Plantation St, Suite 185, Worcester, MA 01605; fred.anderson@umassmed.edu 2009 American College of Chest Physicians. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians ( misc/reprints.xhtml). DOI: /chest CHEST / 136 / 4/ OCTOBER,
2 (VTE) and PE are in excess of $1.5 billion. 10 At the individual patient level, hospital costs incurred by patients in whom VTE complications develop are double those for patients in whom these complications do not develop. 11 Several advisory groups have sponsored initiatives to require all hospitalized patients to be assessed for VTE risk and to have appropriate thromboprophylaxis administered. Despite these efforts, the use of prophylaxis remains unacceptably low for several high-risk groups of patients. In particular, multiple studies 17,18 have demonstrated disparities between surgical and nonsurgical patients in terms of the use of appropriate prophylaxis. These findings highlight the necessity to continue to evaluate the clinical impact of PE on hospitalized surgical and nonsurgical patients and to determine the impact of nationwide initiatives to increase the use of VTE prophylaxis. The objectives of the present study were to determine the recent trends in clinical outcomes and resource utilization for patients hospitalized with a clinically recognized episode of acute PE in the United States. Materials and Methods Data used in this study were obtained from the Nationwide Inpatient Sample (NIS), from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. This database contains information abstracted from approximately 8 million patient hospitalizations per year and comprises a stratified sampling frame of 20% of all US hospital discharges. These data can be used to produce a weighted estimate of approximately 35 to 39 million patient hospitalizations per year. All patient identifiers have been removed from this database. The NIS represents the largest all-payer inpatient care database available and provides the unique opportunity to estimate nationwide trends for hospital admissions related to specific diseases and their associated clinical outcomes. 19,20 Data used for this analysis were adjusted national estimates based on the stratified sampling frame of discharges. The total number of weighted discharges per year reflected in the NIS database were as follows: 34,874,046 Data processing and statistical ana (1998); 35,467,673 (1999); 36,417,565 (2000); 37,187,641 (2001); 37,804,021 (2002); 38,220,659 (2003); 38,661,786 (2004); and 39,163,834 (2005). The NIS database was queried for an 8-year period from January 1, 1998, to December 31, 2005, for patients discharged with primary or secondary PE. These patients were defined according to the International Classification of Diseases, ninth revision (ICD-9), clinical modification codes that correspond to PE ( to ). The total cohort was further stratified according to surgical or nonsurgical hospital discharge status to permit comparison between subgroups. Surgical patients were identified using the ICD-9 clinical modification procedure codes 01 to 86.99, which pertain to major surgical procedures. Codes for minor procedures were excluded, using a method described previously. 21 The total cohort, together with surgical and nonsurgical subgroups, was assessed for baseline characteristics, including age, gender, ethnicity, and type of hospital admission (eg, emergency, urgent, or elective). The analysis of patients baseline characteristics was performed to determine whether certain subgroups of patients with PE were more high risk, therefore skewing the results of our comparisons of clinical outcomes and resource utilization. Recognized risk factors for PE were assessed, including malignancy, previous VTE, obesity (body mass index 30 kg/m 2 ), hormone-replacement therapy, congestive heart failure, prior stroke, coronary artery disease, nonambulatory status, smoking history, comorbid lupus, recent infection, recent hip or long-bone fracture, and clinically reported varicose veins The groups were assessed for specific clinical outcomes related to their current hospital admission, including in-hospital mortality, average length of stay, major bleeding (ie, hemorrhage leading to hemodynamic instability or requiring blood transfusion), and the incidence of heparin-induced thrombocytopenia. Relative resource utilization per hospital admission was estimated using mean hospital charges per PE-related hospital admission. Charges were normalized to 2005 US dollars adjusted to reflect the US consumer price index. Additional analyses were performed to determine whether surgical and nonsurgical patients were at differential risk for adverse outcomes or higher resource utilization. This study was conducted in full compliance with institutional review board policies for clinical research at the University of Massachusetts Medical School (Worcester, MA) and in compliance with rules for data use stipulated by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality in granting the authors access to NIS data. 19,20 Statistical Analysis Data were analyzed and compared using analysis of variance for continuous data and 2 tests for proportions. Variables with a p 0.05 were considered statistically different. Variables that were significantly different between comparison groups underwent further post hoc testing with a Student-Newman-Keuls test. Data processing and statistical analyses were performed with statistical software (SAS, version 9.1; SAS Institute, Inc; Cary, NC). Results Study Population The study population comprised 1,378,670 patients of whom 397,188 (28.8%) were categorized as surgical and 981,482 (71.2%) as nonsurgical. These data represent national estimates extrapolated from the sampling frame of 20% of US hospitals. The estimated number of patients with primary or secondary PE discharged from the hospital each year increased from 126,546 in 1998 to 229,637 in 2005 (Fig 1). Of these discharges in 1998, 72,221 (57%) were given a primary discharge diagnosis of PE and 54,325 (43%) a secondary discharge diagnosis of PE. By 2005, 137,451 (60%) were discharged with primary PE and 92,186 (40%) with secondary PE. Nonsurgical patients accounted for a greater proportion of hospital admissions throughout the study, with 70 to 72% of discharges occurring among nonsurgical patients (Fig 1). Both overall and in the two subgroups, the proportion of white patients decreased, whereas the proportion of African-American patients remained nearly constant (Table 1). The rates of elective hospital admissions decreased, whereas hospital admission rates from the emergency department increased (p in all three groups) [Table 1]. 984 Original Research
3 Similar findings were observed in both the surgical and the nonsurgical subgroups (all p 0.001) [Table 2]. Figure 1. Number of patients treated for PE in US hospitals between 1998 and Risk Factors In the overall cohort, PE hospital admissions related to malignancy, prior VTE, obesity, smoking history, and concurrent infection increased over the study period, whereas hospital admissions with existing hip and extremity fractures decreased (all p 0.01) [Table 2]. Clinical Outcomes Although the absolute number of deaths in patients hospitalized for PE increased, the in-hospital mortality rate decreased over the period of this study from 12.3% (15,591 of 126,546 patients) in 1998 to 8.2% (18,744 of 229,637 patients) in 2005 (Fig 2A). The mean length of stay decreased from 9.4 to 8.6 days (Fig 2B). The incidence of complications related to anticoagulation therapy (major bleeding and heparin-induced thrombocytopenia) remained stable or decreased (Fig 2C and D). The mean total charges associated with hospital discharges for PE increased from $25,293 to $43,740 (Fig 3). Similar decreases in hospital death and length of hospitalization were observed in the surgical and nonsurgical subgroups, but both remained higher in the surgical population (Fig 2A and B). Increases in total costs also were observed and increased at a higher rate in the surgical group than in the nonsurgical group (Fig 3). Discussion This contemporary study is the first of temporal trends (1998 to 2005) in the rates of clinically recog- Table 1 Patients Characteristics in the Overall Cohort and in Surgical and Nonsurgical Cohorts Year Characteristics All patients (n 1,378,670) No. 126, , , , , , , ,637 Women Mean age, yr White African American Emergency admission Elective admission Surgical patients (n 397,188) No. 36,078 39,449 39,613 45,117 52,991 56,055 61,345 66,541 Women Mean age, yr White African American Emergency admission Elective admission Nonsurgical patients (n 981,482) No. 90,468 96, , , , , , ,096 Women Mean age, yr White African American Emergency admission Elective admission Values are presented as % except where indicated. CHEST / 136 / 4/ OCTOBER,
4 Table 2 Risk Factors for Venous Thromboembolism in the Overall Cohort and in Surgical and Nonsurgical Cohorts Year Factors All patients (n 1,378,670) No. 126, , , , , , , ,637 Malignancy Prior VTE Obesity Age 40 yr Hormone replacement Congestive heart failure Prior stroke Coronary artery disease Nonambulatory History of smoking Lupus Concurrent infection Hip or extremity fracture Varicose veins Surgical patients (n 397,188) No. 36,078 39,449 39,613 45,117 52,991 56,055 61,345 66,541 Malignancy Prior VTE Obesity Age 40 yr Hormone replacement Congestive heart failure Prior stroke Coronary artery disease Nonambulatory History of smoking Lupus Concurrent infection Hip or extremity fracture Varicose veins Nonsurgical patients (n 981,482) No. 90,468 96, , , , , , ,096 Malignancy Prior VTE Obesity Age 40 yr Hormone replacement Congestive heart failure Prior stroke Coronary artery disease Nonambulatory History of smoking Lupus Concurrent infection Hip or extremity fracture Varicose veins Values are presented as % except where indicated. nized PE and in-hospital mortality in patients hospitalized in US acute care hospitals. Key findings include a doubling in the number of hospitalized patients with a clinically recognized episode of acute PE combined with a decrease of two-thirds in hospital mortality. These findings were consistent in both surgical and nonsurgical subgroups. The overall trends in the rates of major complications related to anticoagulation therapy (bleeding and heparin-induced thrombocytopenia) remained stable or decreased. Consistent with national trends in length and cost of hospitalization during this period, the duration of hospitalization fell slightly, whereas the average costs associated with hospital admissions for PE increased by 70%. 986 Original Research
5 Figure 2. Outcomes in patients treated for PE in US hospitals between 1998 and A: in-hospital mortality. B: mean length of hospitalization. C: major bleeding. D: heparin-induced thrombocytopenia. Surgical and Nonsurgical Populations Although increases in the number of patients with PE were seen in both the surgical and the nonsurgical populations, the increase was far greater in medical patients. Although we have no data to support these hypotheses, increasing use of d-dimer and spiral CT scanning to diagnose PE 22 and inadequate thromboprophylaxis in US hospitals during this time period may have contributed to the observed increase in diagnoses of PE. 18 Of interest, although improvements in clinical outcomes and length of hospitalization were observed in both the surgical and the nonsurgical populations, these indicators of clinical performance remained notably higher in the surgical subgroup. Although these findings could indicate inferior treatment strategies for surgical patients with PE compared with nonsurgical patients, it is more likely that these disparities reflect the greater acuity of illness associated with surgical diseases. In addition, the inability to fully anticoagulate surgical patients in the short-term postoperative period may have been associated with the observed increase in the incidence of PE. Surgical patients demonstrated greater prevalences of congestive heart failure, prior stroke, and concurrent infection than nonsurgical patients. However, they experienced lower incidences of bleeding complications while being treated for PE. Thus, although mortality and length of stay are greater for surgical patients, these differences seem unlikely to be due to inadequate VTE prophylaxis strategies compared with those used in nonsurgical patients. Previous Studies of the Incidence of PE in the United States An estimate of the annual rate of PE treated in US hospitals was derived from the National Hospital Discharge Survey in 1987 by Gillum, 23 who reported CHEST / 136 / 4/ OCTOBER,
6 Figure 3. Mean total charges in patients treated for PE in US hospitals between 1998 and a decrease from 197,000 episodes of PE in 1975 to 120,000 episodes in Other studies that attempted to determine the incidence of PE in the United States identified PE cases from hospitals in limited geographic areas, leading to uncertainty about the generalizabilty of these findings to the United States as a whole. Using 1986 data, Anderson et al 24 conducted the first US community-wide study of VTE and calculated the attack rate of PE and deep vein thrombosis in patients treated in acute care hospitals within the well-defined region of Worcester, MA, which they extrapolated to 99,000 patients treated for PE in US hospitals per year. Subsequently, Silverstein et al 25 published a landmark study from Olmstead County, MN, in which they identified individuals in whom PE and deep vein thrombosis developed in a 25-year period from 1966 to 1990, observing a 45% decrease in the attack rate of PE. Using 1999 hospital discharges, Spencer et al 26 studied patients in hospitals located in area of Worcester, MA, and extrapolated an estimated 80,000 patients treated for PE in US hospitals. This estimate is lower than the 1999 rate reported here; however, their findings were based on a limited geographic region of the United States, and they subjected ICD-9 hospital discharge codes for PE to direct validation in a review of hospital charts. Study Strengths and Limitations The primary strength of this study is the power afforded to the analysis by the NIS database, which includes a large, representative sample of inpatients with acute PE. The availability of data over an 8-year period allows for a robust and informative study about recent national trends in clinical outcomes and resource utilization for patients with PE. In addition, the database includes all-payer information from 20% of inpatient hospital admissions throughout the United States; therefore, deficiencies common to previous studies, including extrapolation to US-wide estimates from regional populations and data sources for patients hospitalized before 2000, are avoided. Despite these strengths, several important limitations pertain to this study. The NIS database comprises information extracted from hospital discharge summaries, which are subject to coding errors. However, studies using medical record audit have demonstrated that NIS data are coded with adequate sensitivity and specificity. 19,20 Additionally, a satisfactory sensitivity of ICD-9 codes has been demonstrated 27 for identifying patients with objectively confirmed PE. Detailed data are not available for the diagnostic tools used to confirm the diagnosis of PE or the hospital treatments administered (eg, type and findings of diagnostic testing, type and duration of PE prophylaxis or treatment). Another limitation concerns our method of estimating health-care resource utilization through the analysis of mean charges. Typically, charges are significantly higher than actual costs, but cost data were not available for these patients. Despite these limitations, charge data can provide a gross index of resource utilization for these PE-related hospital admissions over the period of the study. Previous estimates of resource utilization were based on extrapolations from much more limited data sets, and no information has been available about trends in resource utilization over consecutive years. Physicians increasing awareness of PE during the period of this survey, with a corresponding increased utilization of increasingly accessible and sensitive diagnostic tests, may be a confounding variable. The observed increase in PErelated hospital admissions may reflect an increase in the detection of minor and asymptomatic PE, which could account for the lower in-hospital mortality and shorter length of hospitalization observed. Although the detection of these minor PEs may diminish the impact of the apparent improvements in clinical outcomes for patients with PE over time, the observed increase in hospital admissions for PE highlights a concerning rise in the clinically apparent prevalence of a largely preventable and potentially lethal disease. A final limitation is our inability to separate PE that developed during hospitalization from PE that developed prior to hospital admission. Because the data extracted for the NIS database are derived from hospital discharge summary diagnostic codes, which do not make this differentiation, it was not possible to make correlations between the temporal onset of PE and the primary diagnosis at hospital admission. This limitation is highlighted by the finding of 988 Original Research
7 Spencer et al 28 that only approximately 25% of VTE episodes are hospital acquired. The results of this current study must be interpreted in light of these limitations. In conclusion, we have provided robust data regarding recent nationwide trends for clinical outcomes and health-care resource utilization for patients with acute PE. Despite steadily increasing hospital admissions for PE over the past 8 years, in-hospital mortality and length of hospitalization have decreased consistently but with an increasing cost for health-care resources. PE remains a major risk for hospitalized patients in the United States. Our findings indicate that important improvements have been made over the past 8 years, possibly due to physicians increased awareness of PE, more aggressive diagnostic testing, and greater use of thromboprophylaxis in high-risk patients. The large proportion of PE identified in patients hospitalized for nonsurgical illness, including clinically recognized and fatal PE, suggests that an opportunity exists to focus quality improvement efforts in US hospitals to further improve patient outcomes. The overall increase in hospital admissions for PE highlights a substantial rise in the prevalence of this largely preventable and potentially lethal disease, and emphasizes the need to continue aggressive surveillance, prophylaxis, and treatment. Acknowledgments Author contributions: Drs. Park, Messina, Ciocca, and Anderson contributed to the study design. Drs. Park, Dargon, Huang, and Anderson performed the data collection/processing. Drs. Park and Huang contributed to statistical analysis. All authors contributed to the manuscript preparation, and Drs. Park, Messina, Ciocca, Huang, and Anderson contributed to the editorial review. Financial/nonfinancial disclosures: Dr. Anderson has received grants from Sanofi-Aventis, The Medicines Company, and Ortho McNeill Jansen. He also has received consulting and speaker fees from GlaxoSmithKline and Sanofi-Aventis. Drs. Park, Messina, Dargon, and Ciocca and Ms. Huang have reported to the ACCP that no significant conflicts of interest exist with any companies or organizations whose products or services may be discussed in this article. Other contributions: We thank Sophie Rushton-Smith, PhD, Medical Writer, Center for Outcomes Research, University of Massachusetts Medical School, for her editorial support in the preparation of this manuscript. References 1 Lindblad B, Sternby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ 1991; 302: Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med 1989; 82: Alikhan R, Peters F, Wilmott R, et al. Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol 2004; 57: Silver D. An overview of venous thromboembolism prophylaxis. Am J Surg 1991; 161: Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107:I Dismuke SE, Wagner EH. Pulmonary embolism as a cause of death: the changing mortality in hospitalized patients. JAMA 1986; 255: Goldhaber SZ, Turpie AG. Prevention of venous thromboembolism among hospitalized medical patients. Circulation 2005; 111:e1 3 8 Zurawska U, Parasuraman S, Goldhaber SZ. Prevention of pulmonary embolism in general surgery patients. Circulation 2007; 115:e302 e307 9 McGarry LJ, Thompson D, Weinstein MC, et al. Cost effectiveness of thromboprophylaxis with a low-molecularweight heparin versus unfractionated heparin in acutely ill medical inpatients. Am J Manag Care 2004; 10: Spyropoulos AC, Hurley JS, Ciesla GN, et al. Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin. Chest 2002; 122: Ollendorf DA, Vera-Llonch M, Oster G. Cost of venous thromboembolism following major orthopedic surgery in hospitalized patients. Am J Health Syst Pharm 2002; 59: Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(suppl): 338S 400S 13 Institute for Clinical Systems Improvement. Health care guideline: venous thromboembolism prophylaxis, Available at: venous_thromboembolism_prophylaxis_4.html. Accessed August 17, American College of Obstetricians and Gynecologists. Prevention of deep vein thrombosis and pulmonary embolism. Washington, DC: American College of Obstetricians and Gynecologists, 2007; ACOG practice bulletin No Joint Commission. Performance measurement initiatives: national consensus standards for prevention and care of venous thromboembolism (VTE). Available at: org/performancemeasurement/performancemeasurement/vte. htm. Accessed August 17, National Institutes for Health and Clinical Excellence. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. Available at: guidance.nice.org.uk/cg46. Accessed August 17, Dentali F, Douketis JD, Gianni M, et al. Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med 2007; 146: Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371: Agency for Healthcare Research and Quality. Introduction to the Nationwide Inpatient Sample (NIS) Rockville, MD: Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Overview of the Nationwide Inpatient Sample (NIS) Available at: Accessed August 17, CHEST / 136 / 4/ OCTOBER,
8 21 Edelsberg J, Hagiwara M, Taneja C, et al. Risk of venous thromboembolism among hospitalized medically ill patients. Am J Health Syst Pharm 2006; 63:S16 S22 22 Qaseem A, Snow V, Barry P, et al. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med 2007; 146: Gillum RF. Pulmonary embolism and thrombophlebitis in the United States, Am Heart J 1987; 114: Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A populationbased perspective of the hospital incidence and casefatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT study. Arch Intern Med 1991; 151: Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158: Spencer FA, Emery C, Lessard D, et al. The Worcester Venous Thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med 2006; 21: Heckbert SR, Kooperberg C, Safford MM, et al. Comparison of self-report, hospital discharge codes, and adjudication of cardiovascular events in the Women s Health Initiative. Am J Epidemiol 2004; 160: Spencer FA, Lessard D, Emery C, et al. Venous thromboembolism in the outpatient setting. Arch Intern Med 2007; 167: Original Research
AN AUDIT: THROMBOPROPHYLAXIS FOR TOTAL HIP REPLACEMENT PATIENTS AT NORTHWICK PARK AND CENTRAL MIDDLESEX HOSPITALS
The West London Medical Journal 2010 Vol 2 No 4 pp 19-24 AN AUDIT: THROMBOPROPHYLAXIS FOR TOTAL HIP REPLACEMENT PATIENTS AT NORTHWICK PARK AND CENTRAL MIDDLESEX HOSPITALS Soneji ND Agni NR Acharya MN Anjari
More informationRisk of venous thromboembolism and benefits of prophylaxis use in hospitalized medically ill US patients up to 180 days post-hospital discharge
ORIGINAL CLINICAL INVESTIGATION Open Access Risk of venous thromboembolism and benefits of prophylaxis use in hospitalized medically ill US patients up to 180 days post-hospital discharge Li Wang 1, Nishan
More informationDATA FROM THE POPULAtion-based
ORIGINAL INVESTIGATION Venous Thromboembolism in the Outpatient Setting Frederick A. Spencer, MD; Darleen Lessard, MS; Cathy Emery, RN; George Reed, PhD; Robert J. Goldberg, PhD Background: There has been
More informationGeneral. Recommendations. Guideline Title. Bibliographic Source(s) Guideline Status. Major Recommendations
General Guideline Title Prevention of deep vein thrombosis and pulmonary embolism. Bibliographic Source(s) American College of Obstetricians and Gynecologists (ACOG). Prevention of deep vein thrombosis
More informationComparison of Venothromboembolism Prophylaxis Practices in a Winnipeg Tertiary Care Hospital to Chest Guidelines: A Quality Improvement Project
Comparison of Venothromboembolism Prophylaxis Practices in a Winnipeg Tertiary Care Hospital to Chest Guidelines: A Quality Improvement Project Dr. Jonathan Laxton, FRCPC, R5 GIM University of Manitoba
More informationPrevalence of pulmonary embolism at autopsy among elderly patients in a Chinese general hospital
Journal of Geriatric Cardiology (2016) 13: 894 898 2016 JGC All rights reserved; www.jgc301.com Research Article Open Access Prevalence of pulmonary embolism at autopsy among elderly patients in a Chinese
More informationVTE Management in Surgical Patients: Optimizing Prophylaxis Strategies
VTE Management in Surgical Patients: Optimizing Prophylaxis Strategies VTE in Surgical Patients: Recognizing the Patients at Risk Pathogenesis of thrombosis: Virchow s triad and VTE Risk Hypercoagulability
More informationNQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE. Measure Information Form. Performance Measure Name: Venous Thromboembolism Prophylaxis
Last Updated: Version 4.3 NQF-ENORSE VOLUNTARY CONSENSUS STANARS FOR HOSPITAL CARE Measure Information Form Measure Set: Venous Thromboembolism (VTE) Set Measure Set I #: Performance Measure Name: Venous
More informationLack of Clinical Benefit of Thromboprophylaxis in Patients Hospitalized in a Medical Unit Over a 10-year Span
Elmer Original Article ress Lack of Clinical Benefit of Thromboprophylaxis in Patients Hospitalized in a Medical Unit Over a 10-year Span Gabrielle Migner-Laurin a, Thomas St-Aubin b, Julie Lapointe b,
More informationPrevention of Venous Thromboembolism in Department of Veterans Affairs Hospitals
ORIGINAL RESEARCH Prevention of Venous Thromboembolism in Department of Veterans Affairs Hospitals Jerome Herbers, MD, MBA Susan Zarter, BSN Department of Veterans Affairs, Office of the Inspector General,
More informationGetting Started Kit VENOUS THROMBOEMBOLISM PREVENTION. Section 2: Evidence-Based Appropriate VTE Prophylaxis
Reducing Harm Improving Healthcare Protecting Canadians VENOUS THROMBOEMBOLISM PREVENTION Getting Started Kit Section 2: Evidence-Based Appropriate VTE Prophylaxis January 2017 www.patientsafetyinstitute.ca
More informationVenous thromboembolism (VTE) is a leading
Original Research Venous Thromboembolism Prophylaxis and the Impact of Standardized Guidelines: Is a Computer-Based Approach Enough? Muhammad Bilal Quraishi, MD, Robert Mathew, DO, Alicia Lowes, MD, Chowdry
More informationVenous Thromboembolism (VTE): Prophylaxis and the Incidence of Hospital Acquired VTE(HAQ VTE) Olaide Akande, MBChB Mentor: John Hall, MD, FACP
Venous Thromboembolism (VTE): Prophylaxis and the Incidence of Hospital Acquired VTE(HAQ VTE) Olaide Akande, MBChB Mentor: John Hall, MD, FACP Outline Rationale Background Objective Methods Results Conclusion
More informationMisunderstandings of Venous thromboembolism prophylaxis
Misunderstandings of Venous thromboembolism prophylaxis Veerendra Chadachan Senior Consultant Dept of General Medicine (Vascular Medicine and Hypertension) Tan Tock Seng Hospital, Singapore Case scenario
More informationA Prospective, Controlled Trial of a Pharmacy- Driven Alert System to Increase Thromboprophylaxis rates in Medical Inpatients
University of New Mexico UNM Digital Repository Undergraduate Medical Student Research Papers Health Sciences Center Student Scholarship 8-20-2009 A Prospective, Controlled Trial of a Pharmacy- Driven
More informationVenous thromboembolism (VTE), which includes
C l i n i c a l R e v i e w A r t i c l e Prevention of Venous Thromboembolism in Hospitalized Medical Patients Brian S. Wojciechowski, MD David A. Cohen, MD Venous thromboembolism (VTE), which includes
More informationEXTENDING VTE PROPHYLAXIS IN ACUTELY ILL MEDICAL PATIENTS
EXTENDING VTE PROPHYLAXIS IN ACUTELY ILL MEDICAL PATIENTS Samuel Z. Goldhaber, MD Director, VTE Research Group Cardiovascular Division Brigham and Women s Hospital Professor of Medicine Harvard Medical
More informationNQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE. Measure Information Form
Last Updated: Version 4.3 NQF-ENORSE VOLUNTARY CONSENSUS STANARS FOR HOSPITAL CARE Measure Information Form Measure Set: Venous Thromboembolism (VTE) Set Measure Set I #: Performance Measure Name: Intensive
More informationEarly Ambulation Reduces the Risk of Venous Thromboembolism After Total Knee Replacement. Marilyn Szekendi, PhD, RN
Early Ambulation Reduces the Risk of Venous Thromboembolism After Total Knee Replacement Marilyn Szekendi, PhD, RN ANA 7 th Annual Nursing Quality Conference, February 2013 Research Team Banafsheh Sadeghi,
More informationSUBJECT: LIMB PNEUMATIC COMPRESSION EFFECTIVE DATE: 06/27/13 DEVICES FOR VENOUS REVISED DATE: 06/26/14 THROMBOEMBOLISM PROPHYLAXIS
MEDICAL POLICY SUBJECT: LIMB PNEUMATIC COMPRESSION PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical
More informationUnderstanding thrombosis in venous thromboembolism. João Morais Head of Cardiology Division and Research Centre Leiria Hospital Centre Portugal
Understanding thrombosis in venous thromboembolism João Morais Head of Cardiology Division and Research Centre Leiria Hospital Centre Portugal Disclosures João Morais On the last year JM received honoraria
More informationProphylaxis against venous thromboembolism in hospitalized medical patients: an evidence based and practical approach
Prophylaxis against venous thromboembolism in hospitalized medical patients: an evidence based and practical approach James D. Douketis, Imran Moinuddin Department of Medicine, McMaster University and
More informationVENOUS THROMBOEMBOLISM: DURATION OF TREATMENT
VENOUS THROMBOEMBOLISM: DURATION OF TREATMENT OBJECTIVE: To provide guidance on the recommended duration of anticoagulant therapy for venous thromboembolism (VTE). BACKGROUND: Recurrent episodes of VTE
More informationWhat You Should Know
1 New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know The American Society
More informationORIGINAL RESEARCH. BACKGROUND: The clinical venous thromboembolism (VTE) burden remains high in the United States, despite guidelines
ORIGINAL RESEARCH Inpatient Thromboprophylaxis Use in U.S. Hospitals: Adherence to the Seventh American College of Chest Physician s Recommendations for At-risk Medical and Surgical Patients Alpesh N.
More informationCite this article as: BMJ, doi: /bmj c (published 26 January 2006)
Cite this article as: BMJ, doi:10.1136/bmj.38733.466748.7c (published 26 January 2006) Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients:
More informationTitle: Low Molecular Weight Heparins (LMWH), fondaparinux (Arixtra)
Origination: 03/29/05 Revised: 09/01/10 Annual Review: 11/20/13 Purpose: To provide guidelines and criteria for the review and decision determination of requests for medications that requires prior authorization.
More informationVenous Thromboembolism Prophylaxis for Medical Service Mostly Cancer Patients at Hospital Discharge
CLINICAL RESEARCH STUDY Venous Thromboembolism Prophylaxis for Medical Service Mostly Cancer Patients at Hospital Discharge John Fanikos, RPh, MBA, a Amanda Rao, BS, b Andrew C. Seger, PharmD, b Gregory
More informationVenous Thromboembolism. Prevention
Venous Thromboembolism Prevention August 2010 Venous Thromboembloism Prevention 1 1 Expected Practice Assess all patients upon admission to the ICU for risk factors of venous thromboembolism (VTE) and
More informationIndications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute
Indications of Anticoagulants; Which Agent to Use for Your Patient? Marc Carrier MD MSc FRCPC Thrombosis Program Ottawa Hospital Research Institute Disclosures Research Support/P.I. Employee Leo Pharma
More informationBACKGROUND AND OBJECTIVE: Hospital-acquired venous thromboembolic events
QUALITY IMPROVEMENT/RISK MANAGEMENT Innovative Approaches to Increase Deep Vein Thrombosis Prophylaxis Rate Resulting in a Decrease in Hospital-Acquired Deep Vein Thrombosis at a Tertiary-Care Teaching
More informationAnnotated EINSTEIN PE NEJM manuscript
Annotated EINSTEIN PE NEJM manuscript 9 Predefined measures ensured that the study was conducted to a high standard and avoided potential bias of the open-label design: 1 Nearly half a million cases of
More informationVenous thromboembolism risk assessment in hospitalised patients: A new proposal
CLINICAL SCIENCE Venous thromboembolism risk assessment in hospitalised patients: A new proposal Carolina Alves Vono Alckmin, I Mariana Dionísia Garcia, II Solange Aparecida Petilo de Carvalho Bricola,
More informationVenous Thrombosis in Asia
Venous Thrombosis in Asia Pantep Angchaisuksiri, M.D. Professor of Medicine, Mahidol University, Thailand Adjunct Associate Professor, University of North Carolina, Chapel Hill, USA Venous Thromboembolism
More informationΣάββας Σουρμελής Διευθυντής Β Ορθοπαιδικής Κλινικής ΔΘΚΑ «Υγεία» Αναγνώριση παραγόντων κινδύνου της φλεβικής θρόμβωσης.
Σάββας Σουρμελής Διευθυντής Β Ορθοπαιδικής Κλινικής ΔΘΚΑ «Υγεία» Αναγνώριση παραγόντων κινδύνου της φλεβικής θρόμβωσης. VTE: deep vein thrombosis (DVT) and pulmonary embolism (PE) PE Migration Embolus
More informationProphylaxis for Thromboembolism in Hospitalized Medical Patients
T h e n e w e ng l a nd j o u r na l o f m e dic i n e clinical practice Prophylaxis for Thromboembolism in Hospitalized Medical Patients Charles W. Francis, M.D. This Journal feature begins with a case
More informationMedical Patients: A Population at Risk
Case Vignette A 68-year-old woman with obesity was admitted to the Medical Service with COPD and pneumonia and was treated with oral corticosteroids, bronchodilators, and antibiotics. She responded well
More informationVenous Thromboembolism National Hospital Inpatient Quality Measures
Venous Thromboembolism National Hospital Inpatient Quality Measures Presentation Overview Review venous thromboembolism as a new mandatory measure set Outline measures with exclusions and documentation
More informationObjectives. Venous Thromboembolism (VTE) Prophylaxis. Case VTE WHY DO IT? Question: Who Is At Risk?
Objectives Venous Thromboembolism (VTE) Prophylaxis Rishi Garg, MD Department of Medicine Identify patients at risk for VTE Options for VTE prophylaxis Current Recommendations (based on The Seventh ACCP
More informationExternal validity of placebo-controlled trials of thromboprophylaxis for medical patients cited in clinical practice guidelines
External validity of placebo-controlled trials of thromboprophylaxis for medical patients cited in clinical practice guidelines S. Morin-Ben Abdallah MD, A. Dutilleul MD, V. Nadon MD, X. Marchand-Sénécal
More informationThromboembolism Prophylaxis in Medical Inpatients: Effect on Outcomes and Costs
n clinical n Thromboembolism Prophylaxis in Medical Inpatients: Effect on Outcomes and Costs Onur Baser, MS, PhD; Nishan Sengupta, PhD; Anne Dysinger, MA; and Li Wang, MA, PhD Objectives: To evaluate the
More informationEpidemiology of first and recurrent venous thromboembolism: A population-based cohort study in patients without active cancer
Blood Coagulation, Fibrinolysis and Cellular Haemostasis 255 Epidemiology of first and recurrent venous thromboembolism: A population-based cohort study in patients without active cancer Carlos Martinez
More informationAnticoagulation for prevention of venous thromboembolism
Anticoagulation for prevention of venous thromboembolism Original article by: Michael Tam Note: updated in June 2009 with the eighth edition (from the seventh) evidence-based clinical practice guidelines
More informationSociety of Trauma Nurses TraumaCon 03/22/2018
Prophylaxis Against Venous Thromboemblism (VTE) in Pediatric Trauma Society of Trauma Nurses TraumaCon 03/22/2018 Arash Mahajerin, MD, MSCr Hematology, CHOC Children s Specialists Orange, CA Disclosure
More information1. SCOPE of GUIDELINE:
Page 1 of 35 CLINICAL PRACTICE GUIDELINE: Venous Thromboembolism (VTE) Prevention Guideline: Thromboprophylaxis AUTHORIZATION: VP, Medicine Date Approved: May 17, 2012 Date Revised: Vancouver Coastal Health
More informationDonald M. Arnold, MD; Susan R. Kahn, MD, MSc; and Ian Shrier, MD, PhD
Missed Opportunities for Prevention of Venous Thromboembolism* An Evaluation of the Use of Thromboprophylaxis Guidelines Donald M. Arnold, MD; Susan R. Kahn, MD, MSc; and Ian Shrier, MD, PhD Objectives:
More informationLow-Molecular-Weight Heparin
Low-Molecular-Weight Heparin Policy Number: Original Effective Date: MM.04.019 10/15/2007 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 05/01/2016 Section: Prescription Drugs
More informationLow-Molecular-Weight Heparin
Low-Molecular-Weight Heparin Policy Number: Original Effective Date: MM.04.019 10/15/2007 Line(s) of Business: Current Effective Date: HMO; PPO 10/28/2011 Section: Prescription Drugs Place(s) of Service:
More informationAspirin as Venous Thromboprophylaxis
Canadian Society of Internal Medicine Nov 2, 2017 Aspirin as Venous Thromboprophylaxis Bill Geerts, MD, FRCPC Thromboembolism Consultant, Sunnybrook HSC Professor of Medicine, University of Toronto Disclosures
More informationSUBJECT: LIMB PNEUMATIC COMPRESSION EFFECTIVE DATE: 06/27/13 DEVICES FOR VENOUS REVISED DATE: 06/26/14, 09/15/15,09/21/17. THROMBOEMBOLISM PROPHYLAXIS
MEDICAL POLICY REVISED DATE: 06/26/14, 09/15/15,09/21/17. PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases,
More informationResults from RE-COVER RE-COVER II RE-MEDY RE-SONATE EXECUTIVE SUMMARY
Assessment of the safety and efficacy of dabigatran etexilate (Pradaxa ) in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and the prevention of recurrent DVT and PE Results from
More informationThe validity of ICD codes coupled with imaging procedure codes for identifying acute venous thromboembolism using administrative data
573839VMJ0010.1177/1358863X15573839Vascular MedicineAlotaibi et al. research-article2015 Original Article The validity of ICD codes coupled with imaging procedure codes for identifying acute venous thromboembolism
More informationVTE in the Trauma Population
VTE in the Trauma Population Erik Peltz, D.O. February 11 th, 2015 * contributions from Eduardo Gonzalez, M.D. University of Colorado T-32 Research Fellow The problem. VTE - Scope of the Problem One of
More informationDVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE)
DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE) Introduction VTE (DVT/PE) is an important complication in hospitalized patients Hospitalization for acute medical illness
More informationVenous Thromboembolism in Heart Failure: Preventable Deaths During and After Hospitalization
CLINICAL RESEARCH STUDY Venous Thromboembolism in Heart : Preventable Deaths During and After Hospitalization Gregory Piazza, MD, a Samuel Z. Goldhaber, MD, a Darleen M. Lessard, MS, b Robert J. Goldberg,
More informationTITLE: Acetylsalicylic Acid for Venous Thromboembolism Prophylaxis: A Review of Clinical Evidence, Benefits and Harms
TITLE: Acetylsalicylic Acid for Venous Thromboembolism Prophylaxis: A Review of Clinical Evidence, Benefits and Harms DATE: 23 August 2011 CONTEXT AND POLICY ISSUES: Thromboembolism occurs when a blood
More informationPREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM
PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM International Consensus Statement 2013 Guidelines According to Scientific Evidence Developed under the auspices of the: Cardiovascular Disease Educational
More informationLow Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders
SURGICAL GRAND ROUNDS March 17 th, 2007 Low Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders Guillermo Escobar, M.D. LMWH vs UFH Jayer s sales pitch: FALSE LMW is
More informationCorporate Medical Policy
Corporate Medical Policy Postsurgical Home Use of Limb Compression Devices for Venous File Name: Origination: Last CAP Review: Next CAP Review: Last Review: postsurgical_home_use_of_limb_ compression_devices_for_vte_prophylaxis
More informationDr Fahad Al-Hameed MD, FCCP, FRCPC Consultant Intensivist & Pulmonologist Professor Asst. of Medicine/Critical Care KSAU-HS Deputy chairman,
Dr Fahad Al-Hameed MD, FCCP, FRCPC Consultant Intensivist & Pulmonologist Professor Asst. of Medicine/Critical Care KSAU-HS Deputy chairman, Intensive Care Department, Director, Ambulatory Care Center
More informationPrevention of Venous Thromboembolism
Prevention of Venous Thromboembolism Surgical Care Improvement Project Dale W. Bratzler, DO, MPH President and CEO Dale W. Bratzler, DO, MPH Oklahoma Foundation for Medical Quality QIOSC Medical Director
More informationVenous Thromboembolism Prophylaxis After Major Orthopaedic Surgery: A Pooled Analysis of Randomized Controlled Trials
Winner of the AAHKS Award Venous Thromboembolism Prophylaxis After Major Orthopaedic Surgery: A Pooled Analysis of Randomized Controlled Trials Greg A. Brown, MD, PhD The Journal of Arthroplasty Vol. 24
More informationBath, Philip M.W. and England, Timothy J. (2009) Thighlength compression stockings and DVT after stroke. Lancet. ISSN (In Press)
Bath, Philip M.W. and England, Timothy J. (2009) Thighlength compression stockings and DVT after stroke. Lancet. ISSN 0140-6736 (In Press) Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/1087/1/lancet_clots_1_20090522_4.pdf
More informationProtocol. Postsurgical Outpatient Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Postsurgical Outpatient Use of Limb Compression Devices for (10128) (Formerly Outpatient Use of Limb Pneumatic Compression Devices for ) Medical Benefit Effective Date: 07/01/14 Next Review Date: 03/15
More informationSymptomatic Venous Thromboembolism after Total Hip/Knee Replacement: A Population-based Taiwan Study
IMPROVING PATIENT SAFETY Preventing & Managing Venous Thromboembolism Session 8 Data Driving Strategies for VTE Prevention and Management 3/30/2012; 15.35-15.55 Symptomatic Venous Thromboembolism after
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/21764 holds various files of this Leiden University dissertation. Author: Mos, Inge Christina Maria Title: A more granular view on pulmonary embolism Issue
More informationCLINICAL RESEARCH STUDY
CLINICAL RESEARCH STUDY Venous Thromboembolism in Patients with Chronic Obstructive Gregory Piazza, MD, MS, a Samuel Z. Goldhaber, MD, a Aimee Kroll, MS, b Robert J. Goldberg, PhD, b Catherine Emery, RN,
More informationThe Epidemiology of Venous Thromboembolism
The Epidemiology of Venous Thromboembolism Richard H. White, MD Abstract Venous thromboembolism (VTE) occurs for the first time in 100 persons per 100,000 each year in the United States, and rises exponentially
More informationMeasurement and Improvement of Quality of Cardiovascular Care DR : DEHESTANI
Measurement and Improvement of Quality of Cardiovascular Care DR : DEHESTANI Hospitals For hospitals in the United States, measures of cardiovascular care mandated by the Joint Commission have recently
More informationResearch Article Comparison of Chemical and Mechanical Prophylaxis of Venous Thromboembolism in Nonsurgical Mechanically Ventilated Patients
rombosis Volume 2015, Article ID 849142, 6 pages http://dx.doi.org/10.1155/2015/849142 Research Article Comparison of Chemical and Mechanical Prophylaxis of Venous Thromboembolism in Nonsurgical Mechanically
More informationProphylaxis for Venous Thromboembolism Following Total Knee Arthroplasty: A Survey of Korean Knee Surgeons
Original Article Knee Surg Relat Res 2016;28(3):207-212 http://dx.doi.org/10.5792/ksrr.2016.28.3.207 pissn 2234-0726 eissn 2234-2451 Knee Surgery & Related Research Prophylaxis for Venous Thromboembolism
More information*Note: Blue Cross of California only may pay for CTU with any surgical procedure and only E0218 is billed
Sequential Compression (DVT) E0676 Pneumatic Compression Device (DVTcare, Covidien, DonJoy, Thermotek) E0676 is based on carrier discretion. Some carriers are billed as monthly rate, some as daily rate
More informationPreventing venous thromboembolism in long-term care residents: Cautious advice based on limited data
REVIEW CME CREDIT EDUCATIONAL OBJECTIVE: Readers will consider which long-term care residents should or should not be considered for thromboprophylaxis Menaka Pai, MD, FRCP(C) Department of Medicine, McMaster
More informationWhat is the risk of venous thromboembolism (VTE) in patients treated by an Outpatient Parenteral Antimicrobial Therapy (OPAT) Service?
What is the risk of venous thromboembolism (VTE) in patients treated by an Outpatient Parenteral Antimicrobial Therapy (OPAT) Service? David A. Barr; Sharon Irvine; Neil D. Ritchie; Jay McCutcheon; R.
More informationPostsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Clinical Position Statement Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis Effective: October 2017 Next Review: September 2018 CLINICAL POSITION STATEMENT Postsurgical
More informationSlide 1. Slide 2. Slide 3. Outline of This Presentation
Slide 1 Current Approaches to Venous Thromboembolism Prevention in Orthopedic Patients Hujefa Vora, MD Maria Fox, RN June 9, 2017 Slide 2 Slide 3 Outline of This Presentation Pathophysiology of venous
More informationLink between effectiveness and cost data Costing was conducted prospectively on the same patient sample as that used in the effectiveness analysis.
Clinical and economic effectiveness of an inpatient anticoagulation service Mamdani M M, Racine E, McCreadie S, Zimmerman C, O'Sullivan T L, Jensen G, Ragatzki P, Stevenson J G Record Status This is a
More informationChapter. A higher risk of recurrent venous thrombosis in men is due to hormonal risk factors in women in thrombophilic families
Chapter A higher risk of recurrent venous thrombosis in men is due to hormonal risk factors in women in thrombophilic families Willem M. Lijfering Nic J.G.M. Veeger Saskia Middeldorp Karly Hamulyák Martin
More informationTop Ten Reasons For Failure To Prevent Postoperative Thrombosis
Top Ten Reasons For Failure To Prevent Postoperative Thrombosis Joseph A. Caprini, MD, MS, FACS, RVT, FACCWS Louis W. Biegler Chair of Surgery NorthShore University HealthSystem, Evanston, IL Clinical
More informationMEDICAL POLICY SUBJECT: LIMB PNEUMATIC COMPRESSION DEVICES FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS
MEDICAL POLICY SUBJECT: LIMB PNEUMATIC COMPRESSION REVISED DATE: 06/26/14, 10/15/15, 06/16/16, PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria
More informationVenous Thromboembolism Prophylaxis - Why Should We Care? Harry Gibbs FRACP FCSANZ Vascular Physician The Alfred Hospital
Venous Thromboembolism Prophylaxis - Why Should We Care? Harry Gibbs FRACP FCSANZ Vascular Physician The Alfred Hospital VTE is common and dangerous 5 VTE is Common VTE Incidence: 1.5 / 1000 per year
More informationMonitoring of Thromboembolic Events Prophylaxis: Where Do We Stand?
Elmer ress Original Article J Hematol. 2015;4(4):223-227 Monitoring of Thromboembolic Events Prophylaxis: Where Do We Stand? Laleh Mahmoudi a, Soha Namazi a, Shiva Nemati a, Ramin Niknam b, c, Abstract
More informationVenous Thromboembolism Prophylaxis: Checked!
Venous Thromboembolism Prophylaxis: Checked! William Geerts, MD, FRCPC Director, Thromboembolism Program, Sunnybrook HSC Professor of Medicine, University of Toronto National Lead, VTE Prevention, Safer
More informationAdam Goldfarb, M.A., D.C., D.E.S.S. Introduction
Venous Thromboembolism Prophylaxis following Lower Extremity Orthopedic Surgery: A Review of the Biomedical Research Literature and Evidence-Based Policy in the United States. Adam Goldfarb, M.A., D.C.,
More informationDrug Class Review Newer Oral Anticoagulant Drugs
Drug Class Review Newer Oral Anticoagulant Drugs Final Original Report May 2016 The purpose of reports is to make available information regarding the comparative clinical effectiveness and harms of different
More informationFINDINGS FROM THE GLOBAL ORTHOPAEDIC REGISTRY
Arthroplasty Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events FINDINGS FROM THE GLOBAL ORTHOPAEDIC
More informationCost-effectiveness of screening for deep vein thrombosis by ultrasound at admission to stroke rehabilitation Wilson R D, Murray P K
Cost-effectiveness of screening for deep vein thrombosis by ultrasound at admission to stroke rehabilitation Wilson R D, Murray P K Record Status This is a critical abstract of an economic evaluation that
More informationWhat evidence exists that describes the efficacy of mechanical prophylaxis for venous thromboembolism (VTE) in adult surgical patients?
July 2015 Rapid Review Evidence Summary McGill University Health Centre: Division of Nursing Research and MUHC Libraries What evidence exists that describes the efficacy of mechanical prophylaxis for venous
More informationFactor Xa Inhibition in the Management of Venous Thromboembolism: Important Safety Information. Important Safety Information (cont d)
Factor Xa Inhibition in the Management of Venous Thromboembolism: The Role of Fondaparinux WARNING: SPINAL/EPIDURAL HEMATOMAS Epidural or spinal hematomas may occur in patients who are anticoagulated with
More informationClinical Policy: Dalteparin (Fragmin) Reference Number: ERX.SPA.207 Effective Date:
Clinical Policy: (Fragmin) Reference Number: ERX.SPA.207 Effective Date: 01.11.17 Last Review Date: 11.17 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationHISTORICALLY, INSERTION
ORIGINAL INVESTIGATION A Population-Based Study of Inferior Vena Cava Filters in Patients With Acute Venous Thromboembolism Frederick A. Spencer, MD; Shannon M. Bates, MD; Robert J. Goldberg, PhD; Darleen
More informationRESEARCH. Venous thromboprophylaxis in UK medical inpatients
Venous thrombo in UK medical inpatients STRashid 1 MRThursz 2 N A Razvi 3 RVoller 4 TOrchard 2 STRashid 5 A A Shlebak 2 J R Soc Med 2005;98:507 512 SUMMARY We prospectively assessed the implementation
More informationLIMB COMPRESSION DEVICES FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS
PROPHYLAXIS Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs are dependent
More informationThrombosis Prophylaxis and Mortality Risk Among Critically Ill Adults
[ Original Research Critical Care ] Thrombosis Prophylaxis and Mortality Risk Among Critically Ill Adults Craig M. Lilly, MD, FCCP ; Xinggang Liu, MD, PhD ; Omar Badawi, PharmD, MPH ; Christine S. Franey,
More informationOutcome LMWH ASA LMWH ASA
Page 1 of 15 TABLE E-1 Incidence of Postoperative VTE Events and Major Bleeding* Total Hip Arthroplasty Total Knee Arthroplasty Outcome LMWH ASA LMWH ASA Symptomatic DVT 0.011 0.017 0.024 0.038 Symptomatic
More informationIs thromboprophylaxis effective in reducing the pulmonary thromboembolism?
Is thromboprophylaxis effective in reducing the pulmonary thromboembolism? Fereshteh Rajabi (1), Masoumeh Sadeghi (2), Fereshteh Karbasian (3), Ali Torkan (4) Abstract BACKGROUND: Deep vein thrombosis
More informationCOMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP)
The European Agency for the Evaluation of Medicinal Products Evaluation of Medicines for Human Use London, 16 December 1999 COMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP) NOTE FOR GUIDANCE ON CLINICAL
More informationORIGINAL ARTICLES SECTION II. Prevalence and Risk Factors for Symptomatic Thromboembolic Events after Shoulder Arthroplasty
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 448, pp. 152 156 2006 Lippincott Williams & Wilkins SECTION II ORIGINAL ARTICLES Prevalence and Risk Factors for Symptomatic Thromboembolic Events after
More informationDiagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism
Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Diagnosis and Treatment of Deep Venous Thrombosis and Pulmonary Embolism Summary Number 68 Overview Venous thromboembolism
More informationIncidence of Diagnosed Deep Vein Thrombosis in the General Population: Systematic Review
Eur J Vasc Endovasc Surg 25, 1±5 (2003) doi:10.1053/ejvs.2002.1778, available online at http://www.sciencedirect.com on REVIEW Incidence of Diagnosed Deep Vein Thrombosis in the General Population: Systematic
More information