Education and clinical pharmacist-led management strategies for the risk and prophylaxis of venous thromboembolism in general surgery

Abstract

Background Despite the risks of venous thromboembolism (VTE) in surgical patients are well defined, primary thromboprophylaxis (TP) can be neglected. The aim of this study was to evaluate the risk of VTE and appropriateness of TP and to assess the effects of education and clinical pharmacy (CP) services. Methods This study was conducted in a total of 3 periods (n = 800): pre-education (n = 340), post-education (n = 269) and CP intervention period (n = 191) and the risk of VTE and the appropriateness of TP were evaluated. At the end of pre-education period, patients were re-evaluated after education was given about the guidelines on TP and an educative poster was posted in the services (post-education period). During the CP intervention period, the CP made recommendations in terms of optimal TP use to the physicians in charge. Results While there was no significant difference in the optimal TP rate administered to the patients before and after education (138/340, 40.6% vs. 122/269, 45.4%; p = 0.238); this rate was increased to 113/191 (59.2%) in the CP intervention period (p = 0.004). High-risk patients who received one type of TP constituted the majority of patients who did not receive optimal TP. While the ratio of high-risk patients undergoing a single type of TP in the pre- and post-education periods (104/340, 30.6% vs. 83/269, 30.9%), was similar (p = 0.819); with the CP interventions, this rate was reduced to 35/191 (18.3%) (p = 0.001). Conclusion Even though education has positive influence on surgeons, the implementation of CP practices is more effective especially in terms of maintaining optimal TP.

Efficacy and safety of direct oral anticoagulants versus low-molecular-weight heparin for thromboprophylaxis after cancer surgery: a systematic review and meta-analysis

“…The degree of VTE risk in patients undergoing cancer surgery varies according to the type and duration of surgery, immobilization status of the patient and the presence of other VTE risks in the cancer surgery patient [ 4 ]. In our meta-analysis, there was a low 30-day postoperative rate of VTE between the DOAC and LMWH groups (3.5% vs. 4.6%), which is similar to that previously reported in other cancer-related surgery trials [ 21 , 22 ].…”

“…This increased twofold risk of VTE in patients with known cancer vs. non-cancer patients undergoing the same surgery [ 3 ]. Education for the risk assessment and prophylaxis of VTE and considering guidelines are important for making the optimal thromboprophylaxis decision [ 4 ]. Current guidelines [ 5 – 8 ] recommend the use of VTE prophylaxis with 7–10 days of low-molecular-weight heparin (LMWH) or unfractionated heparin in patients who underwent cancer-related surgery, and 4 weeks extended-duration LMWHs prophylaxis for abdominal-pelvic surgery because of the significantly reduced incidence of VTE without increasing bleeding complications or mortality [ 9 , 10 ].…”