Journal of thrombosis and thrombolysis
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J. Thromb. Thrombolysis · Feb 2010
Development of national performance measures on the prevention and treatment of venous thromboembolism.
Venous thromboembolism (VTE) remains a significant public health problem in the United States, particularly for hospitalized patients. Approximately two-thirds of all VTE events are associated with recent hospitalization. ⋯ In addition to the organizational policy statement and 17 preferred practices, eight national performance measures addressing various aspects of VTE prevention and care have been endorsed. There is now a broad consensus on standardized measures of quality for the prevention and treatment of VTE, and a national commitment to collect and publicly report data on the quality of care for this important health problem.
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J. Thromb. Thrombolysis · Feb 2010
Designing and implementing effective venous thromboembolism prevention protocols: lessons from collaborative efforts.
Hospital acquired venous thromboembolism (VTE) is a major source of morbidity and mortality, yet proven prevention measures are often underutilized. The lack of a validated VTE risk assessment model, difficulty integrating VTE risk assessment and prevention protocols into the routine process of care, and the lack of standardized metrics for VTE prophylaxis have all been barriers. Recently, a VTE risk assessment/prevention protocol has been validated, leading to portable strategies achieving breakthrough levels of adequate prophylaxis in a variety of inpatient settings. ⋯ A VTE prevention protocol is defined as a VTE risk assessment with no more than three levels of risk, tightly linked to recommended prophylaxis for each level. A balance between the need to provide protocol guidance and the need for efficiency and ease-of-use by the clinician must be maintained. The power of this protocol driven approach is bolstered by a quality improvement framework, multidisciplinary teams, ongoing monitoring of the process, and real time identification and mitigation of non-adherents via a technique that measures progress and prompts concurrent intervention, an approach we call "measure-vention."
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Apixaban, an oral direct factor Xa inhibitor, is currently in late stage clinical development for the prevention and treatment of thromboembolic diseases. In comparison with current treatment standards for venous thromboembolism (VTE) prophylaxis, apixaban has shown decreased rates of clinically significant bleeding with mixed results in terms of non-inferiority for VTE events. ⋯ A large, international phase III clinical study (APPRAISE-2) of apixaban following acute coronary syndrome is currently underway. Large, phase III studies testing apixaban for the prevention of vascular events in subjects with non-valvular atrial fibrillation are also ongoing.
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J. Thromb. Thrombolysis · Aug 2009
Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia.
Subtle decreases in platelet count may impede timely recognition of heparin-induced thrombocytopenia (HIT), placing the patient at increased risk of thrombotic events. ⋯ Implementation of a CDSS did not appear to improve the ability to detect and respond to potential HIT, but resulted in increased laboratory testing and changes in clinician reactions to decreasing platelet counts that deserve further study.