This document discusses strategies to help Canadian hospitals meet accreditation requirements for venous thromboembolism (VTE) prophylaxis. It provides information on developing a written VTE prophylaxis policy and guidelines, identifying at-risk patients, establishing measures of success, educating health professionals, and auditing practices to drive improvements. The high risk of VTE in hospital patients, its fatal consequences, and the preventability of VTE with safe and inexpensive measures are emphasized. Strategies discussed include developing hospital leadership and committees, following clinical practice guidelines, keeping policies simple, embedding prophylaxis in order sets, making its use mandatory, and involving various stakeholders.
POUR AANS 1226 presentation A. Bashee[1]Azam Basheer
This document reports on a study examining the incidence and risk factors of postoperative urinary retention (POUR) in neurosurgical patients. The study found that the overall incidence of POUR was 39.4% in a cohort of 137 neurosurgical patients. Male patients, those over 60 years old, and those undergoing spine surgery were at highest risk. Patients who developed POUR had longer hospital stays. The results suggest POUR is common in neurosurgery and identifying risk factors could help reduce its occurrence and negative impacts.
CPG: Prevention and Treatment of Venous Thromboembolism (VTE)Khairunnisa Zamri
This document provides guidelines for the prevention and treatment of venous thromboembolism (VTE). It defines VTE as deep vein thrombosis and pulmonary embolism. It discusses the epidemiology, causes, risk factors, pathophysiology and various methods for prophylaxis and treatment of VTE, including pharmacological agents such as low molecular weight heparins, fondaparinux, vitamin K antagonists, and new oral anticoagulants. It also covers topics such as risk assessment, timing of prophylaxis, duration of treatment and switching between different anticoagulation agents.
Despitetheroutineuseofprophylacticsystemicantibiotics,sternalwoundin- fection still occurs in 5% or more of cardiac surgical patients and is associated with signifi- cant excess morbidity, mortality, and cost. The gentamicin-collagen sponge, a surgically implantable topical antibiotic, is currently approved in 54 countries. A large, 2-center, ran- domized trial in Sweden reported in 2005 that the sponge reduced surgical site infection by 50% in cardiac patients.
Hysterectomy for benign conditions in a university hospital in2Tariq Mohammed
This study examined 251 women who underwent hysterectomies for benign conditions at a university hospital in Saudi Arabia between 1990 and 2002. The most common indications for hysterectomy were uterine fibroids (41.6%) and dysfunctional uterine bleeding (27.1%). Most abdominal hysterectomies (79%) were performed for fibroids and bleeding, while most vaginal hysterectomies (21%) were for uterine prolapse. Overall complication rates were 33.5% for abdominal hysterectomy and 30.4% for both procedures combined, with the most common complication being postoperative infection (18.7%).
This document discusses anticoagulation options for coronary procedures. Unfractionated heparin (UFH) is the most cost-effective option. The goals of anticoagulation are to prevent radial artery occlusion after angiography, avoid complications like stent thrombosis during percutaneous coronary intervention (PCI), and reduce bleeding. UFH 5000 IU is effective for preventing radial occlusion after angiography. For planned PCI, STEMI, or NSTEMI, UFH or low molecular weight heparin are first-line options, though bivalirudin reduces bleeding. The benefit of bivalirudin may be mitigated for radial procedures and its high cost is a limitation. More data is needed on anticoagulant
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
Cardiogenic shock is a leading cause of death in AMI patients, with mortality rates between 30-60%. While radial access has been shown to reduce bleeding complications, patients presenting with cardiogenic shock are often treated via transfemoral access. Recent studies have demonstrated that radial access PCI is feasible in cardiogenic shock patients, with one study showing a reduction in in-hospital mortality for radial versus transfemoral access. However, experienced radial centers only use the radial approach in around 50% of cardiogenic shock cases, indicating radial access is still underutilized despite potential benefits in this high-risk group.
POUR AANS 1226 presentation A. Bashee[1]Azam Basheer
This document reports on a study examining the incidence and risk factors of postoperative urinary retention (POUR) in neurosurgical patients. The study found that the overall incidence of POUR was 39.4% in a cohort of 137 neurosurgical patients. Male patients, those over 60 years old, and those undergoing spine surgery were at highest risk. Patients who developed POUR had longer hospital stays. The results suggest POUR is common in neurosurgery and identifying risk factors could help reduce its occurrence and negative impacts.
CPG: Prevention and Treatment of Venous Thromboembolism (VTE)Khairunnisa Zamri
This document provides guidelines for the prevention and treatment of venous thromboembolism (VTE). It defines VTE as deep vein thrombosis and pulmonary embolism. It discusses the epidemiology, causes, risk factors, pathophysiology and various methods for prophylaxis and treatment of VTE, including pharmacological agents such as low molecular weight heparins, fondaparinux, vitamin K antagonists, and new oral anticoagulants. It also covers topics such as risk assessment, timing of prophylaxis, duration of treatment and switching between different anticoagulation agents.
Despitetheroutineuseofprophylacticsystemicantibiotics,sternalwoundin- fection still occurs in 5% or more of cardiac surgical patients and is associated with signifi- cant excess morbidity, mortality, and cost. The gentamicin-collagen sponge, a surgically implantable topical antibiotic, is currently approved in 54 countries. A large, 2-center, ran- domized trial in Sweden reported in 2005 that the sponge reduced surgical site infection by 50% in cardiac patients.
Hysterectomy for benign conditions in a university hospital in2Tariq Mohammed
This study examined 251 women who underwent hysterectomies for benign conditions at a university hospital in Saudi Arabia between 1990 and 2002. The most common indications for hysterectomy were uterine fibroids (41.6%) and dysfunctional uterine bleeding (27.1%). Most abdominal hysterectomies (79%) were performed for fibroids and bleeding, while most vaginal hysterectomies (21%) were for uterine prolapse. Overall complication rates were 33.5% for abdominal hysterectomy and 30.4% for both procedures combined, with the most common complication being postoperative infection (18.7%).
This document discusses anticoagulation options for coronary procedures. Unfractionated heparin (UFH) is the most cost-effective option. The goals of anticoagulation are to prevent radial artery occlusion after angiography, avoid complications like stent thrombosis during percutaneous coronary intervention (PCI), and reduce bleeding. UFH 5000 IU is effective for preventing radial occlusion after angiography. For planned PCI, STEMI, or NSTEMI, UFH or low molecular weight heparin are first-line options, though bivalirudin reduces bleeding. The benefit of bivalirudin may be mitigated for radial procedures and its high cost is a limitation. More data is needed on anticoagulant
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
Cardiogenic shock is a leading cause of death in AMI patients, with mortality rates between 30-60%. While radial access has been shown to reduce bleeding complications, patients presenting with cardiogenic shock are often treated via transfemoral access. Recent studies have demonstrated that radial access PCI is feasible in cardiogenic shock patients, with one study showing a reduction in in-hospital mortality for radial versus transfemoral access. However, experienced radial centers only use the radial approach in around 50% of cardiogenic shock cases, indicating radial access is still underutilized despite potential benefits in this high-risk group.
This document summarizes a study presented by Lukasz Koltowski on quality of life in patients undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) via radial or femoral access. The study was a single-center, randomized trial that assessed quality of life measures like the EQ-5D and MacNew scales at various time points after PCI. The results showed that radial access was associated with better short-term quality of life, especially for mobility and anxiety/depression, though differences diminished after a few days. The conclusions were that radial access facilitated quicker recovery and should be preferred when considering patient satisfaction.
This document discusses the patient pathway for suspected non-massive pulmonary embolism (PE) at the authors' trust. It utilizes a pre-test probability assessment and D-dimer testing before imaging. If the pre-test probability is low, a negative D-dimer can exclude PE without imaging. For higher probability or positive D-dimer, CT pulmonary angiogram is the preferred imaging test. The pathway can safely exclude PE in around a quarter of patients without unnecessary imaging. The document also discusses considerations for different imaging options and the need to investigate patients with unprovoked PE for underlying malignancy.
This document discusses radiation exposure for interventional cardiologists and strategies to reduce it. It notes that radiation is a known carcinogen and some studies have found increased cancer risks for interventionalists. While one study found a modest increase in radiation with radial access, experience level is also important. The document reviews techniques like using lead shields and skirts, lowering frame rates, and newer equipment to reduce radiation by up to 62%. Lead drapes and caps have been shown to reduce operator radiation by 75-81% in randomized trials. The conclusion is that while radiation and orthopedic injuries are major occupational hazards, strategies exist to better protect interventionalists.
Intraluminal coronary thrombus aspiration in patients with STEMI. Prof. Andre...Chaichuk Sergiy
Intraluminal coronary thrombus aspiration in patients with STEMI was studied in randomized trials. Results showed thrombus aspiration before stenting improved myocardial perfusion scores and ST-segment resolution compared to conventional PCI alone. Meta-analyses found manual thrombus aspiration reduced distal embolization and improved angiographic and electrocardiographic outcomes, while its effect on mortality is unclear. Larger randomized trials are still needed to definitively establish the benefits of routine thrombus aspiration in STEMI.
This document summarizes several studies on the risk of acute kidney injury following percutaneous coronary intervention (PCI) via the radial versus femoral artery access site. Registry data from British Columbia and a large US study found that femoral access was associated with significantly higher odds of adverse kidney outcomes after adjusting for risk factors. A single-center study also found higher rates of post-PCI acute kidney injury with femoral compared to radial access after propensity matching. While patient characteristics and contrast load are major risk factors for procedure-associated acute kidney injury, available data suggests radial access may have renoprotective effects compared to the femoral approach.
This document discusses the use of a slender 6Fr intra-aortic balloon pump (IABP) system compared to the standard 8Fr system. A study of 42 patients undergoing elective percutaneous coronary intervention with prophylactic IABP support found no complications with the 6Fr system, while the 8Fr system had re-bleeding and hematoma in some patients. The 6Fr system also allowed for shorter bed rest time. Trans-brachial insertion of the 6Fr IABP had even shorter bed rest and hospital stay times than transfemoral insertion. However, the 6Fr system has limitations such as a small balloon volume and inability to monitor pressure or use radial approaches.
Classification and Regression Tree Analysis in Biomedical Research Salford Systems
This document discusses using classification and regression tree (CART) analysis to develop clinical decision rules for three clinical settings: 1) emergency department triage of HIV-infected patients, 2) survival prediction of patients with colon and rectal cancer, and 3) prediction of neurologic survival in patients following out-of-hospital cardiac arrest. For each setting, the document describes developing CART models using various clinical variables to classify patients into risk groups and reports validation results for predicting outcomes like medical urgency and survival.
What is the place of CT coronary angiography in ED chest pain?kellyam18
CT coronary angiography is a relatively new modality for identifying coronary artery disease. What is its place in ED chest pain assessment. See the evidence -and the evidence gaps- and judge for yourself where it might fit!
This study evaluated the functional result after percutaneous coronary intervention (PCI) with drug-eluting stents in patients with long coronary lesions. The study found that an optimal functional result, defined as a post-PCI fractional flow reserve (FFR) of greater than 0.95, was only achieved in 12% of patients. Only 16% of patients had a desirable post-PCI FFR of 0.91 to 0.95. The majority, 72%, had a post-PCI FFR of 0.90 or less. While angiographic results at 9-month follow-up were satisfactory, the rate of functional restenosis was approximately three times higher than the angiographic restenosis rate. The 2-year
Same Wrist Intervention via the Cubital (Ulnar) Artery in Case of Radial Puncture Failure for Percutaneous Cardiac Catheterization or Intervention: The Multicenter Prospective SWITCH Registry
This document provides guidance on starting a successful transradial cardiac catheterization program. It discusses how the author started their program during fellowship by attending courses and enrolling patients in clinical trials. It highlights advantages of transradial access such as reduced access complications, earlier ambulation, and improved patient comfort. The document also reviews data demonstrating reduced bleeding and improved outcomes with transradial compared to transfemoral access. Overall, it presents a case for transradial access and provides tips for establishing a successful transradial program.
This document discusses tips and tricks for successful transradial primary PCI. It begins with an introduction and disclosure from the author. It then reviews several studies that found high rates of success (90-100%) and normalization of coronary blood flow with transradial PCI for AMI. No major vascular complications occurred in these studies. Additional studies showed similar success rates and procedural times for transradial PCI compared to transfemoral, with lower rates of major vascular complications. Bleeding complications were associated with increased mortality. The experience of over 880 AMIs at one center using a transradial approach found no major vascular complications. While transradial PCI can present challenges in complex cases, it allows intervention even if thrombolysis was used
Структура «Реперфузионной Сети» Чешской Республики. Первичное стентирование д...Chaichuk Sergiy
The document proposes new certification requirements for interventional cardiologists in the Czech Republic based on European models. It recommends interventional cardiology become a certified subspecialty after completing cardiology training. The proposed requirements include 1 year of full-time interventional cardiology training, courses, publications, and a final board exam. Accredited centers must have experienced trainers, cath labs, ICU, and imaging. Up to 100 experienced interventional cardiologists could be initially certified without the exam to start the program.
This document summarizes a systematic review and meta-analysis comparing radiation exposure between transradial and transfemoral access for cardiac catheterization. The analysis included 68 studies with over 666,000 patients. It found that while transradial access was initially associated with slightly higher fluoroscopy times and dose-area products, the difference has decreased over time as operator experience has increased, and recent studies show less than a 1 minute difference between approaches. Transradial access may also reduce operator radiation exposure.
This document discusses anticoagulation options for percutaneous coronary intervention (PCI). It summarizes trials comparing unfractionated heparin (UFH) to bivalirudin. The HEAT-PPCI trial found UFH was better than bivalirudin for reducing major adverse cardiac events, with equivalent rates of major bleeding. A meta-analysis of 16 trials found UFH reduced MACE compared to bivalirudin, with equivalent major bleeding when provisional glycoprotein IIb/IIIa inhibitors were used symmetrically. The document concludes that UFH at doses of 50-70 units/kg is the preferred anticoagulant for PCI based on superior efficacy and equivalent safety compared to b
This document discusses the use of bivalirudin as an anticoagulant for PCI procedures. It summarizes data from several clinical trials showing that bivalirudin reduces bleeding risks compared to unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor, without increasing ischemic risks. The presentation argues that since bleeding is a common complication of PCI and is associated with worse outcomes, and bivalirudin reduces bleeding while maintaining efficacy, it should be the preferred anticoagulant for PCI procedures for all patients. It acknowledges that while risk models can identify patients at higher risk of bleeding, it is difficult to separate bleeding risk from ischemic risk.
Abstract del Dr. Hector Ferral acerca del manejo endovascular de la CCSVI en pacientes portadores de Esclerosis Múltiple.
El Dr. Ferral se licenció en Medicina en la ciudad de Mexico, Universidad Anahuac (1979-1985)
Residencia en Medicina Interna: Instituto nacional de Nutricion 1986-1988
Residencia en Radiologia: Instituto nacional de Nutrición: 1988-1991
Fellowship en Intervencionismo: Universidad de Minnesota, Minneapolis : 1991-1993
Attending, Profesor asociado: Lousiana State University, New Orleans: 1995-2000
Attending: Profesor Asociado: University of Texas, San Antonio: 2000-2003
Attending: Profesor de Radiologia: Jefe del Servicio de Intervencionismo, Rush University, Chicago: 2004-2011
Attending: North Shore University: Evanston, Chicago Dic. 2011 a la fecha
más información en www.cdyte.com
Helping Canadian Hospitals Meet Accreditation Requirements For VTE Prophylaxisvtesimplified
This document provides information about preventing venous thromboembolism (VTE) in hospitalized patients. It discusses that VTE is common in hospitals and can be fatal if a blood clot dislodges and causes a pulmonary embolism. The document outlines risk factors for VTE in different patient populations and notes that VTE is preventable through prophylaxis. It emphasizes that preventing VTE should be standard care for most hospitalized patients.
2 vte education for healthcare professionalsvtesimplified
1. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is common in hospitalized patients and can be fatal if unprevented.
2. The risk of VTE is increased by patient factors like age, obesity, and immobility, as well as medical conditions and treatments including surgery, trauma, and cancer.
3. VTE is preventable through the use of prophylactic measures like low molecular weight heparins, and preventing VTE is considered the standard of care for most hospitalized patients.
This document summarizes a study presented by Lukasz Koltowski on quality of life in patients undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) via radial or femoral access. The study was a single-center, randomized trial that assessed quality of life measures like the EQ-5D and MacNew scales at various time points after PCI. The results showed that radial access was associated with better short-term quality of life, especially for mobility and anxiety/depression, though differences diminished after a few days. The conclusions were that radial access facilitated quicker recovery and should be preferred when considering patient satisfaction.
This document discusses the patient pathway for suspected non-massive pulmonary embolism (PE) at the authors' trust. It utilizes a pre-test probability assessment and D-dimer testing before imaging. If the pre-test probability is low, a negative D-dimer can exclude PE without imaging. For higher probability or positive D-dimer, CT pulmonary angiogram is the preferred imaging test. The pathway can safely exclude PE in around a quarter of patients without unnecessary imaging. The document also discusses considerations for different imaging options and the need to investigate patients with unprovoked PE for underlying malignancy.
This document discusses radiation exposure for interventional cardiologists and strategies to reduce it. It notes that radiation is a known carcinogen and some studies have found increased cancer risks for interventionalists. While one study found a modest increase in radiation with radial access, experience level is also important. The document reviews techniques like using lead shields and skirts, lowering frame rates, and newer equipment to reduce radiation by up to 62%. Lead drapes and caps have been shown to reduce operator radiation by 75-81% in randomized trials. The conclusion is that while radiation and orthopedic injuries are major occupational hazards, strategies exist to better protect interventionalists.
Intraluminal coronary thrombus aspiration in patients with STEMI. Prof. Andre...Chaichuk Sergiy
Intraluminal coronary thrombus aspiration in patients with STEMI was studied in randomized trials. Results showed thrombus aspiration before stenting improved myocardial perfusion scores and ST-segment resolution compared to conventional PCI alone. Meta-analyses found manual thrombus aspiration reduced distal embolization and improved angiographic and electrocardiographic outcomes, while its effect on mortality is unclear. Larger randomized trials are still needed to definitively establish the benefits of routine thrombus aspiration in STEMI.
This document summarizes several studies on the risk of acute kidney injury following percutaneous coronary intervention (PCI) via the radial versus femoral artery access site. Registry data from British Columbia and a large US study found that femoral access was associated with significantly higher odds of adverse kidney outcomes after adjusting for risk factors. A single-center study also found higher rates of post-PCI acute kidney injury with femoral compared to radial access after propensity matching. While patient characteristics and contrast load are major risk factors for procedure-associated acute kidney injury, available data suggests radial access may have renoprotective effects compared to the femoral approach.
This document discusses the use of a slender 6Fr intra-aortic balloon pump (IABP) system compared to the standard 8Fr system. A study of 42 patients undergoing elective percutaneous coronary intervention with prophylactic IABP support found no complications with the 6Fr system, while the 8Fr system had re-bleeding and hematoma in some patients. The 6Fr system also allowed for shorter bed rest time. Trans-brachial insertion of the 6Fr IABP had even shorter bed rest and hospital stay times than transfemoral insertion. However, the 6Fr system has limitations such as a small balloon volume and inability to monitor pressure or use radial approaches.
Classification and Regression Tree Analysis in Biomedical Research Salford Systems
This document discusses using classification and regression tree (CART) analysis to develop clinical decision rules for three clinical settings: 1) emergency department triage of HIV-infected patients, 2) survival prediction of patients with colon and rectal cancer, and 3) prediction of neurologic survival in patients following out-of-hospital cardiac arrest. For each setting, the document describes developing CART models using various clinical variables to classify patients into risk groups and reports validation results for predicting outcomes like medical urgency and survival.
What is the place of CT coronary angiography in ED chest pain?kellyam18
CT coronary angiography is a relatively new modality for identifying coronary artery disease. What is its place in ED chest pain assessment. See the evidence -and the evidence gaps- and judge for yourself where it might fit!
This study evaluated the functional result after percutaneous coronary intervention (PCI) with drug-eluting stents in patients with long coronary lesions. The study found that an optimal functional result, defined as a post-PCI fractional flow reserve (FFR) of greater than 0.95, was only achieved in 12% of patients. Only 16% of patients had a desirable post-PCI FFR of 0.91 to 0.95. The majority, 72%, had a post-PCI FFR of 0.90 or less. While angiographic results at 9-month follow-up were satisfactory, the rate of functional restenosis was approximately three times higher than the angiographic restenosis rate. The 2-year
Same Wrist Intervention via the Cubital (Ulnar) Artery in Case of Radial Puncture Failure for Percutaneous Cardiac Catheterization or Intervention: The Multicenter Prospective SWITCH Registry
This document provides guidance on starting a successful transradial cardiac catheterization program. It discusses how the author started their program during fellowship by attending courses and enrolling patients in clinical trials. It highlights advantages of transradial access such as reduced access complications, earlier ambulation, and improved patient comfort. The document also reviews data demonstrating reduced bleeding and improved outcomes with transradial compared to transfemoral access. Overall, it presents a case for transradial access and provides tips for establishing a successful transradial program.
This document discusses tips and tricks for successful transradial primary PCI. It begins with an introduction and disclosure from the author. It then reviews several studies that found high rates of success (90-100%) and normalization of coronary blood flow with transradial PCI for AMI. No major vascular complications occurred in these studies. Additional studies showed similar success rates and procedural times for transradial PCI compared to transfemoral, with lower rates of major vascular complications. Bleeding complications were associated with increased mortality. The experience of over 880 AMIs at one center using a transradial approach found no major vascular complications. While transradial PCI can present challenges in complex cases, it allows intervention even if thrombolysis was used
Структура «Реперфузионной Сети» Чешской Республики. Первичное стентирование д...Chaichuk Sergiy
The document proposes new certification requirements for interventional cardiologists in the Czech Republic based on European models. It recommends interventional cardiology become a certified subspecialty after completing cardiology training. The proposed requirements include 1 year of full-time interventional cardiology training, courses, publications, and a final board exam. Accredited centers must have experienced trainers, cath labs, ICU, and imaging. Up to 100 experienced interventional cardiologists could be initially certified without the exam to start the program.
This document summarizes a systematic review and meta-analysis comparing radiation exposure between transradial and transfemoral access for cardiac catheterization. The analysis included 68 studies with over 666,000 patients. It found that while transradial access was initially associated with slightly higher fluoroscopy times and dose-area products, the difference has decreased over time as operator experience has increased, and recent studies show less than a 1 minute difference between approaches. Transradial access may also reduce operator radiation exposure.
This document discusses anticoagulation options for percutaneous coronary intervention (PCI). It summarizes trials comparing unfractionated heparin (UFH) to bivalirudin. The HEAT-PPCI trial found UFH was better than bivalirudin for reducing major adverse cardiac events, with equivalent rates of major bleeding. A meta-analysis of 16 trials found UFH reduced MACE compared to bivalirudin, with equivalent major bleeding when provisional glycoprotein IIb/IIIa inhibitors were used symmetrically. The document concludes that UFH at doses of 50-70 units/kg is the preferred anticoagulant for PCI based on superior efficacy and equivalent safety compared to b
This document discusses the use of bivalirudin as an anticoagulant for PCI procedures. It summarizes data from several clinical trials showing that bivalirudin reduces bleeding risks compared to unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor, without increasing ischemic risks. The presentation argues that since bleeding is a common complication of PCI and is associated with worse outcomes, and bivalirudin reduces bleeding while maintaining efficacy, it should be the preferred anticoagulant for PCI procedures for all patients. It acknowledges that while risk models can identify patients at higher risk of bleeding, it is difficult to separate bleeding risk from ischemic risk.
Abstract del Dr. Hector Ferral acerca del manejo endovascular de la CCSVI en pacientes portadores de Esclerosis Múltiple.
El Dr. Ferral se licenció en Medicina en la ciudad de Mexico, Universidad Anahuac (1979-1985)
Residencia en Medicina Interna: Instituto nacional de Nutricion 1986-1988
Residencia en Radiologia: Instituto nacional de Nutrición: 1988-1991
Fellowship en Intervencionismo: Universidad de Minnesota, Minneapolis : 1991-1993
Attending, Profesor asociado: Lousiana State University, New Orleans: 1995-2000
Attending: Profesor Asociado: University of Texas, San Antonio: 2000-2003
Attending: Profesor de Radiologia: Jefe del Servicio de Intervencionismo, Rush University, Chicago: 2004-2011
Attending: North Shore University: Evanston, Chicago Dic. 2011 a la fecha
más información en www.cdyte.com
Helping Canadian Hospitals Meet Accreditation Requirements For VTE Prophylaxisvtesimplified
This document provides information about preventing venous thromboembolism (VTE) in hospitalized patients. It discusses that VTE is common in hospitals and can be fatal if a blood clot dislodges and causes a pulmonary embolism. The document outlines risk factors for VTE in different patient populations and notes that VTE is preventable through prophylaxis. It emphasizes that preventing VTE should be standard care for most hospitalized patients.
2 vte education for healthcare professionalsvtesimplified
1. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is common in hospitalized patients and can be fatal if unprevented.
2. The risk of VTE is increased by patient factors like age, obesity, and immobility, as well as medical conditions and treatments including surgery, trauma, and cancer.
3. VTE is preventable through the use of prophylactic measures like low molecular weight heparins, and preventing VTE is considered the standard of care for most hospitalized patients.
1. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is common in hospitalized patients and can be fatal if unprevented.
2. VTE prophylaxis with low molecular weight heparins (LMWHs) or mechanical methods is the standard of care for nearly all hospitalized patients to prevent DVT and PE in a safe and inexpensive way.
3. Despite the risks of VTE, international studies have found that only about half of at-risk patients in hospitals receive the recommended prophylaxis, showing a need for improved guidelines and compliance.
D. Doppler ultrasound of the leg would be the most appropriate initial intervention given the history provided. While RICE and NSAIDs would be reasonable for a muscle strain, the presentation of new onset calf pain after prolonged exercise in a retired individual raises suspicion for deep vein thrombosis, which should be evaluated with Doppler ultrasound. Plain films and antibiotics are not indicated based on the information given.
This document discusses venous thromboembolism (VTE) prophylaxis for medical patients in the hospital. It covers the importance and impact of VTE, guidelines and measures for VTE prophylaxis, types and use of pharmaceutical and mechanical VTE prophylaxis, contraindications, and ways to improve patient compliance. The goal is to understand how to properly apply VTE prophylaxis to reduce preventable hospital deaths from VTE events like pulmonary embolism and deep vein thrombosis.
The document discusses venous thromboembolism (VTE) risk assessment and prophylaxis for hospitalized medical patients. It provides recommendations from American Society of Hematology 2018 guidelines and Indonesian Thrombosis and Hemostasis Society 2018 national guidelines. The recommendations suggest using low molecular weight heparin or unfractionated heparin for VTE prophylaxis in acutely ill or critically ill medical patients based on their risk assessment scores. Mechanical prophylaxis alone or combined with pharmacological prophylaxis is conditionally recommended if patients cannot receive anticoagulants. Extended duration outpatient prophylaxis after hospital discharge is not routinely recommended.
dvt prophylaxis, in icu, deep venous thrombosis prophylaxis ,gagan brar
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is extraordinarily common in hospitalized patients. Risk factors for VTE include immobilization, surgery, trauma, cancer, and thrombophilia. Prediction models can help assess patient risk, though require validation. Primary prophylaxis is preferred to prevent VTE and includes mechanical methods like intermittent pneumatic compression and graduated compression stockings, as well as pharmacologic agents like unfractionated heparin, low molecular weight heparins, and fondaparinux. These options aim to reduce the risk of VTE complications while minimizing bleeding risks.
This document provides an overview of the internal educational program (IEP) of the Vanderbilt University Division of Trauma, Emergency Surgery and Surgical Critical Care. The goal of the IEP is to explore topics related to trauma care from pre-hospital care to injury prevention. The program will outline the full continuum of care provided to trauma patients. It then introduces the trauma team members and multidisciplinary liaisons that will be involved in the educational sessions. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
This document provides guidelines for venous thromboembolism (VTE) prophylaxis in oncology outpatients. It outlines that cancer patients have a higher risk of VTE than non-cancer patients. It introduces a risk assessment tool called the Khorana risk score to help identify high-risk outpatients. For patients at high risk, the document recommends considering prophylaxis with a low molecular weight heparin at prophylactic doses. It provides guidance on choosing an appropriate anticoagulant based on renal function, dosing, monitoring, and patient education. The goal is to reduce VTE risk in high-risk oncology outpatients through a standardized prophylaxis protocol.
Venous thromboembolism (VTE) manifests as deep vein thrombosis (DVT) or pulmonary embolism (PE) from thrombus formation in the venous circulation. Risk factors include immobilization, surgery, trauma, cancer, and genetic hypercoagulable states. Symptoms are nonspecific so objective tests like ultrasound or CT scan are needed to diagnose. Prevention involves pharmacologic methods like blood thinners or compression stockings, and non-pharmacologic methods like early ambulation. Treatment consists of acute blood thinners followed by long-term oral anticoagulants to prevent recurrence, with duration depending on provoking factors.
The document discusses prophylaxis for deep vein thrombosis (DVT). It defines DVT and describes its pathophysiology. Risk factors for DVT include surgery, immobilization, old age, cancer, and inherited or acquired thrombophilias. Without prophylaxis, DVT can occur in 40-60% of major orthopedic surgeries and lead to pulmonary embolism. Methods of prophylaxis include mechanical methods like mobilization and compression devices as well as pharmacological methods like low molecular weight heparin, factor Xa inhibitors, and vitamin K antagonists. Guidelines recommend different prophylaxis options based on surgery type and patient risk factors
The document summarizes guidelines from the CHEST for antithrombotic therapy for venous thromboembolism (VTE) disease. It defines VTE, provides diagnostic criteria and testing recommendations, and outlines treatment guidelines. The guidelines recommend non-vitamin K antagonist oral anticoagulants over warfarin for initial VTE treatment. They also suggest aspirin for extended deep vein thrombosis treatment and note differences from previous versions, including that warfarin is no longer first-line and factors for extended anticoagulation.
Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, most frequently in the leg. Part of the clot can break off and travel to the lungs, called a pulmonary embolism (PE), blocking blood flow. Together DVT and PE are called venous thromboembolism (VTE). VTE is a leading cause of preventable hospital deaths worldwide. While symptoms are often absent, complications of DVT include post-thrombotic syndrome and pulmonary hypertension, and complications of PE include permanent lung damage or sudden death. Studies show the incidence of VTE to be higher in India than previously believed, with orthopedic surgeries significantly increasing risk without prophylaxis
The document summarizes a hospital's venous thromboembolism (VTE) prophylaxis program over 7 years. It shows that the program reduced hospital-acquired deep vein thrombosis and pulmonary embolism by over two-thirds, saving over $6 million in costs. Moving forward, the hospital aims to further improve prophylaxis practices by focusing on areas like daily ambulation and administering prophylaxis in the emergency department and throughout a patient's care. The goal is continuous quality improvement to help more patients and potentially achieve outcomes like preventing all hospital-acquired infections.
This document discusses deep vein thrombosis (DVT) prevention and management following total hip arthroplasty (THA) and total knee arthroplasty (TKA). It summarizes guidelines from the American College of Chest Physicians (ACCP) and the American Academy of Orthopaedic Surgeons (AAOS) on thromboprophylaxis. Key points include:
- ACCP guidelines historically focused on DVT prevention and favored potent anticoagulants, but underestimated bleeding risks. AAOS advocated using symptomatic outcomes.
- Concerns with ACCP included conflicts of interest, prohibiting less aggressive options, and lack of applicability to orthopedic patients.
- 2012 ACCP guidelines addressed orthopedic
The document presents a care process model (CPM) for reducing venous thromboembolism (VTE) events in hospitalized patients through improved prophylaxis. It outlines a 5-step quality improvement process: 1) drafting an evidence-based VTE protocol, 2) analyzing current care delivery, 3) setting performance tracking, 4) introducing a VTE order sheet and high reliability strategies, and 5) perfecting strategies through Plan-Do-Study-Act cycles and tracking. Key aspects of the CPM include a multidisciplinary team approach, risk assessment tools, prophylaxis protocols, and metrics to monitor the percentage of patients assessed and receiving appropriate prophylaxis. Challenges to implementation are discussed along
The document provides information on acute myeloid leukemia (AML), including its definition, risk factors, signs and symptoms, diagnostic tests, pathophysiology, treatment options including chemotherapy, stem cell transplant, and radiation therapy. It discusses complications related to the disease and its treatment, as well as prognostic factors like cytogenetics and gene mutations. A case study is also included describing a patient's admission, treatment, and nursing care for AML.
Anemo 2015-18-Santagostino- Gestione perioperatoria del paziente emofilicoanemo_site
This document discusses perioperative management of patients with hemophilia undergoing surgery. It provides global survey data on bleeding disorder prevalence. It describes hemophilia classifications and diagnostic testing. Factor level targets and treatment methods like bolus dosing or continuous infusion are discussed for surgery in hemophilia patients without and with inhibitors. Considerations include comorbidities, thrombosis risk, and postoperative rehabilitation. The goal is safe surgical hemostasis and recovery for patients with hemophilia.
Incidence of VTE in the First Postoperative 24 Hours after Abdominopelvic Sur...semualkaira
A good number of research reports the incidence of postoperative venous thromboembolism (VTE) mostly
looks at longer postoperative duration, usually days after surgery.
1.2. Objective: We investigated the incidence of early asymptomatic VTE (24 hours postoperatively) to assess the relevance of generalisation of extended post-hospital discharge chemoprophylaxis
Similar to 1 vte and kit education for healthcare professionals and administrators (20)
Prevention and Treatment of Blood Clotsvtesimplified
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
VTE and Cancer Healthcare Professional Educationvtesimplified
Cancer patients are at increased risk of developing blood clots (venous thromboembolism or VTE) due to factors such as tumour infiltration of blood vessels, immobility, and cancer treatments. VTE is a leading cause of death in cancer patients and the risk is highest in the first months after diagnosis. Guidelines recommend thromboprophylaxis for hospitalized cancer patients without bleeding risk, but evidence for routine outpatient prophylaxis is limited to certain high risk groups. Risk assessment tools can help identify those at highest risk who may benefit most from prophylaxis.
This document provides guidance on conducting audits to assess appropriate use of venous thromboembolism (VTE) prophylaxis in hospitals. It describes snap-shot and detailed audits, resources needed, steps to conduct audits, and how to report and disseminate results to drive quality improvement. The goal is to help close any gaps between evidence-based guidelines and actual clinical practice of VTE prophylaxis prescription and use.
2. Deep vein thrombosis
(DVT) forms in a vein of
the leg.
• Characterized by pain,
swelling or tenderness
of the leg, sometimes
with redness and
warmth
Deep Vein Thrombosis
3. Pulmonary Embolism
Pulmonary embolism (PE) occurs when the
blood clot breaks loose and travels to the lungs
• Characterized by shortness of breath, sharp
rib/chest pain and occasionally by
hemoptysis, light-headedness, or collapse
4. Symptoms and Signs of DVT
• Leg pain (90%)
• Tenderness (85%)
• Ankle edema (76%)
• Calf swelling (42%)
• Dilated veins (33%)
• Dusky discoloration
(30%)
• Warmth
• Redness
DVT cannot be reliably
diagnosed on the basis of
history and physical exam, even
in high-risk patients.
Symptomatic DVT
Most hospitalized
patients with DVT
will have NO
SYMPTOMS or SIGNS!
5. Risk of VTE in
Hospitalized Patients
Geerts WT, et al. Chest 2008;358:381S-453S.
Patient Group DVT Prevalence (%)
Medical Patients 10-20
General Surgery 15-40
Major Gynecologic Surgery 15-40
Major Urologic Surgery 15-40
Neurosurgery 15-40
Stroke 20-50
Hip and Knee Arthroplasty,
Hip Fracture Surgery
40-60
Major Trauma 40-80
Spinal Cord Injury 60-80
Critical Care Patients 10-80
6. Pulmonary Embolism
Hospital Risk
•Accounts for 10% of
hospital deaths
•In the UK, PE following
DVT causes between
25,000 and 32,000
deaths each year1
International, cross-
sectional audit of
35,000 inpatients at
risk for VTE found:2
•only 59% of
surgical patients and
40% of medical
patients received
recommended
prophylaxis.
1. UK House of Commons Health Committee. HC 99. Published on 8 March 2005.
2. Cohen AT, et al. Lancet 2008;371:387-394.
7. Characterization of VTE events
In the Worcester County, Mass VTE Study
•60-70% of VTE events were considered to be
provoked by:
• Recent hospitalization (within 3 months)
• Surgery
• Trauma/fracture
• Pregnancy
1. Spencer FA, et al. Arch Intern Med 2007;167:1471-5.
2. Spencer FA, et al. J Thromb Thrombolysis 2009;28:401-9.
Risk for VTE increases with the
number of risk factors and
persists after hospital
discharge.
9. Adapted from: Greer IA. Bailliere’s Clin Obstet Gynaecol 1997;11:403-30.
The risk of DVT and PE is
increased by several factors,
including:
Factors intrinsic to the
patient
Factors related to
underlying disease or
medical condition
Factors introduced by
medical or surgical
treatment
• Age
• Obesity
• Immobility
• History of thrombosis
• Thrombophilia
• Varicose veins
• Venous insufficiency
• Pregnancy
• Trauma
• Heart failure/MI
• Malignancy
• Concomitant
medication
• Chemotherapy
• Orthopaedic surgery
• Major surgery
• Caesarean section
10. 1. VTE is common in hospital patients
2. VTE is fatal (acutely and long-term)
3. VTE is preventable (safely and
inexpensively)
4. Preventing VTE is the standard of
care for almost all hospital patients
in 2011
Slide courtesy of Dr. William Geerts.
Rationale for Thromboprophylaxis
13. Key steps to ensure compliance with ROP:
1.Development of written policy/guideline
2.Identifies clients at risk & provides VTE prophylaxis
3.Establishes measures of success, uses information to make improvements
4.Provides information to health professionals (on risks & prevention measures)
14. 1. Hospital commitment; committee, leadership
2. Follow the ACCP guidelines
3. Written hospital policy on prophylaxis
4. Keep it simple and standardize it
5. Use order sets, computer order entry
6. Make prophylaxis decision mandatory
7. Involve everyone – MD, RN, pharm, patients
8. Audit and feedback to improve best practices
8 steps:
Slide courtesy of Dr. William Geerts.
Local Strategies to Improve
Thromboprophylaxis Success
16. Audrey’s Story
Following a one week wait for surgery and the successful
removal of a benign tumour – Audrey developed a PE.
We are scared and worried about our surgery
or primary reason for being in the hospital as it
is. We rely on you to make us aware of any
possible complications. For me, the blood clot
was far scarier and worse than my brain
tumour and operation.
This experience with the blood clot has
impacted my life. It was the scariest and worst
experience I have ever had and it has left me
fearful and anxious.
“My plea to healthcare professionals: make sure you get people’s
attention, and make sure they fully understand their risks and
what can be done to prevent a blood clot.”
17. • Written hospital policy on VTE prophylaxis
• Opt-out policy for all medical and surgical in-
hospital patients
• VTE prophylaxis embedded in hospital order
sets
Policy ensures prophylaxis is considered
resulting in lower rates of VTE in
hospital setting
Hospital Commitment for VTE
Prophylaxis should include:
18. • Simplicity = single choice
• LMWH advantages over UFH:
• once a day administration
• lower rates of heparin induced
thrombocytopenia
• availability in prefilled syringes
Written hospital policy on
prophylaxis - Simplicity
LMWH: low molecular weight heparin; UFH: unfractionated heparin
19. • Due to differences in LMWH molecule size
and charge, longer chained and more
charged LMWHs like tinzaparin do not
appear to require dose adjustments in
patients with:
• impaired renal function1
• renal failure2,3
• on haemodialysis2,3
• Dose reduction may be necessary with
shorter chain LMWHs (i.e. enoxaparin)
Use of LMWHs in
Renal Impairment
1. Mahé O, et al.Thromb Haemost 2007;97:581-6.
2. PROTECT Investigators. N Engl J Med 2011;364:1305-14.
3. Nutescu EA, et al. Ann Pharmacother 2009;43:1064-83.
20. 1. Hospital commitment, committee, continued
leadership
2. Written hospital policy on prophylaxis
3. Keep policy simple and standardize it
4. Use embedded order sets &/or computer
order entry
5. Make prophylaxis decision mandatory
(i.e. opt-out policy)
1. Involve everyone – MD, RN, pharm, patients
2. Audit and feedback essential to measure
success and identify problems areas
Implementation
Slide courtesy of Dr. William Geerts.
21. 96%
Success with Policy and Embedding
Appropriate Prophylaxis*
(use in General IM Patients)
9%
2003 2007 2008 2009
21%
100%
75%
50%
25%
0
60%
*based on direct chart audit
Quality improvement in action!Slide courtesy of Dr. William Geerts.
22. Vigilance is Key:
Appropriate Prophylaxis* Use in
General IM Patients
9%
2003 2007 2008 2009 2010
21%
100%
75%
50%
25%
0
60%
96%
*based on direct chart audit
We opened the champagne too soon!
72%
Slide courtesy of Dr. William Geerts.
24. •Best practices in VTE
prophylaxis
•Clinical order set
•Audit material
•Health Professional
education material
•Patient education
material
The Content
25. • Reginald E. Smith, PharmD, ACPR, (Chair) Clinical
Pharmacy Specialist, Thrombosis Clinic, BC
• William Geerts, MD, FRCPC, National lead, VTE Prevention,
Safer Healthcare Now! Thromboembolism Specialist;
Professor of Medicine, University of Toronto, ON
• Artemis Diamantouros, BScPharm, MEd, National
Coordinator, VTE Prevention, Safer Healthcare Now!; KT
Pharmacist, ON
• Glenn Whiteway, BScPharm, PharmD, Pharmacy Clinical
Manager; Adjunct Professor, Dalhousie University, NB
• Mary Pederson, BScPharm, Clinical Practise Leader, AB
• Patrick Robertson, BSP, PharmD, Manager Pharmacy
Services, SK
• William Semchuk, MSc, PharmD, FCSHP, Manager
Pharmacy Services, SK
• Ritesh Mistry, MD, CCFP, Hospitalist; Clinical Assistant
Professor, McMaster University, ON
Developed by Canadian experts
26. • Sylvie Desmarais, MD, FRCPC, CSPQ, Internal and
Vascular Medicine Internist, QC
• James Douketis, MD, FRCPC, FACP, FCCP,
Professor, McMaster University, ON
• Jeannine Kassis, MD, FRCPC, Hematologist;
Professor of Medicine, Université de Montréal, QC
• Robin McLeod, MD, FRCSC, FACP, Professor of
Surgery and Health Policy, University of Toronto, ON
• Otto Moodley, MD, FRCPC, Clinical Hematologist,
SK
Reviewed by Canadian experts
28. Weight Based vs. Fixed Dosing
• fixed doses of LMWH in a prefilled syringe (i.e.
tinzaparin 4 500 U subcutaneously once daily) is
the simplest regimen for most patients.
• obese patients (>100 kg, BMI>35 kg/m2
) require
higher doses of LMWH than the non-obese
• use fixed dosing for patients between 50-100 kg
and adjust dosing for others
Prevention of VTE in Hospitalized
Patients:
Summary of Good Practice
29. Tinzaparin dosing considerations according to weight
• 50-100 kg: tinzaparin 4 500 units sc once a day
• <50 kg: tinzaparin 3 500 units sc once a day
Clinical order sets for a predominately obese
population may warrant two or three weight ranges
using prefilled syringe sizes.
• 100-150 kg: tinzaparin 10 000 units sc once a day
• 151-200 kg: tinzaparin 14 000 units sc once a day
Prevention of VTE in Hospitalized
Patients:
Summary of Good Practice
Speaker Notes: Venous Thromboembolism is the collective term for deep vein thrombosis and pulmonary embolism. It may help to refer to DVTs as vein blood clots to patients to help them differentiate between blood clots in the legs and blood clots in the brain (stroke). 50% of DVTs produce no symptoms or signs, with the first awareness of a DVT being a pulmonary embolism (PE).
Speaker Notes: One serious risk of venous thrombosis is part of the clot breaking away and being carried by the blood to the lungs. This is known as a pulmonary embolism (PE). The clot interferes with oxygenation of blood in the lungs and can therefore be fatal.
Speaker Notes: Approximately 50% of patients have some of the expected symptoms and signs of DVT. However, most hospitalized patients, will have no symptoms or signs. Clinical diagnosis is unreliable, thus definitive diagnosis requires a Doppler ultrasound.
05/03/13 17:01 Speaker Notes: This table from the ACCP Consensus Guidelines highlights the risk for venous thromboembolic disease in patients that have not been prophylaxed. Medical patients have a prevalence of DVT in the absence of prophylaxis, of up 10% to 20%, while critical care patients have a 10% to 80% risk. It is important to note that these percentages represent asymptomatic DVTs. Surgery patients have had most of the attention with regard to VTE prophylaxis. Unlike surgery patients, the majority of prophylaxis-eligible medical patients are not receiving any prophylaxis or appropriate prophylaxis. Reference: Geerts WT, et al . Chest . 2008;358:381S-453S.
Speaker Notes: In the UK, PE following DVT causes between 25,000 and 32,000 deaths each year, this exceeds the combined total deaths from breast cancer, AIDS and traffic accidents. References: UK House of Commons Health Committee. HC 99. Published on 8 March 2005. Cohen AT, et al . Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371:387-394.
Speaker Notes: The 2009 study examined all patients (n=1 567 patients) with a first-time VTE in Worchester County, Massachusetts from 1999 to 2003. The study also found that: 72% of patients were “community acquired” VTE 20% of all events were unprovoked 30% were thought to be related to malignancy Using an expected rate of 60% - that means that in Ontario the hospital-acquired VTE rate is about 8 000/year. References: Spencer FA, et al . Venous thromboembolism in the outpatient setting. Arch Intern Med. 2007;167:1471-5. Spencer FA, et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis. 2009;28:401-409. Heit J, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med. 2002;162:1245–1248. Heit J. The Epidemiology of Venous Thromboembolism in the Community. Arterioscler Thromb Vasc Biol. 2008;28: 370–372.
Speaker Notes : “ Patients without risk factors for VTE are called outpatients .” G. Maynard (2010) Epidemiological data suggest an incidence in the general population of: 1 160 per 100,000 for DVT 120 per 100,000 for PE In those over age 65 this increases to: 2 655 per 100,000 for DVT (4-fold increase) 255 per 100,000 for PE References: O’Shaughnessy D.F. Haemostasis and Thrombosis: Current Clinical Practice: Low-Molecular-Weight Heparins in The Prophylaxis and Treatment of Thrombo-Embolic Disease. Hematol. 2000;4:373-380. Stein PD, et al. Venous thromboembolism according to age: the impact of an aging population. Arch Intern Med. 2004;164:2260-2265 .
Speaker Notes: 60-70% of all VTE is hospital-acquired (i.e. this is a public health issue). Pulmonary embolism is the commonest preventable cause of hospital death.
Speaker Notes: Required Organizational Practice (ROP) for VTE.
Speaker Notes: The ROP provides key compliance tests, and more importantly key steps to ensure hospital-wide compliance.
Speaker Notes: Remind the groups that patients at risk of VTE can look quite different.
Speaker Notes: This is a real story. Here is more of it: I was in a hospital bed attached to an IV pole for one week waiting for my surgery. My surgery was successful, although the anesthesia left me feeling unwell. I went home to recuperate but continued to feel unwell, and had limited mobility due to an ongoing problem with my leg. Five days after I was released from hospital I could not stop coughing and I felt quite faint. Upon return to the ER it was discovered I had an enormous blood clot in my lungs- both of them. I ended up in the ICU on an anticoagulant and had to have special medication to dissolve the clot because it was so big and threatened my life. This experience with the blood clot has impacted my life. It was the scariest and worst experience I have ever had and it has left me fearful and anxious. It was a horrifying experience and one I never want to go through again, and I hope no one else has to go through either.
Speaker Notes: Because of differences in the molecules, long chained/charged innohep and UFH can better bind to endothelial cells, be cleared by the reticulo-endothelial pathway, and are less affected/do not appear to accumulate in patients with renal impairment Tinzaparin can be safely used in patients with CrCl below 30 mL/min. References: Mahé O, et al. Tinzaparin and enoxaparin given at prophylactic dose for eight days in medical elderly patients with impaired renal function: a comparative pharmacokinetic study. Thromb Haemost. 2007;97:581-6. PROTECT Investigators. Dalteparin versus unfractionated heparin in critically ill patients. N Engl J Med. 2011;364:1305-14. Nutescu EA, et al. Low-molecular-weight heparins in renal impairment and obesity: available evidence and clinical practice recommendations across medical and surgical settings . Ann Pharmacother. 2009;43:1064-83.
Speaker Notes: This data shows the VTE prophylaxis audit outcomes for one hospital between 2003 and 2009. It clearly demonstrates the success and improvement in VTE prophylaxis when a hospital has VTE protocols, embedded order sets, simple LMWH dosing, regular audits and staff awareness.
Speaker Notes: This data is from the same hospital, with the addition of the audit data from 2010. It shows that despite well developed policies and systems, vigilance and continued staff awareness is key to continued success.
Speaker Notes: The VTE Prevention Simplified Kit was developed by a group of Canadian experts to address a need in hospitals setting up protocols to meet the Accreditation Canada ROP. These experts developed tools, rather than policies or guidelines, to assist hospitals with the implementation of the VTE prophylaxis ROP. All of the material has been provided as electronic templates in order that hospitals may adapt the material to meet their own policies and procedures. The focus of this kit is on best practices in the use of tinzaparin or innohep ® .
Speaker Notes: The kit has 4 main sections: Introduction: introduction to kit and Best practices in VTE prophylaxis Tools: Clinical order set, audit material Education: healthcare professional and patient education material Other: room to add additional Clinical order sets and information in the future
Speaker Notes: These Canadian experts developed and approved all of the material.
Speaker Notes: These Canadian specialists reviewed and approved all of the material.
Speaker Notes: Prophylaxis of VTE works best when there is a system-wide approach within a hospital. The best way to accomplish this is to embed orders for prophylaxis in clinical order sets, such that prophylaxis is routine and inclusive. Limiting choices for VTE prophylaxis to keep it simple. Only one or two choices are sufficient in most situations. The summary of good practice reviews all of the above and provides expert opinion. UFH:low dose unfractionated heparin LMWH: low molecular weight heparin
Speaker Notes: There is evidence that obese patients (>100 kg, BMI>35 kg/ m 2 ) require higher doses of LMWH than non-obese patients. However, fixed doses of LMWH in a prefilled syringe (i.e. tinzaparin 4 500 U subcutaneously once daily) is the simplest regimen for most patients. One way to solve this issue on the clinical order set is to have a fixed dose for the most common weight ranges, with adjusted dosing for those at the weight extremes (<50 or >100 kg). Another consideration is that fixed dose syringes reduce costs with less wastage. They also reduce errors as patient weights and dosing do not need to be determined.
Speaker Notes: The above dosing recommendations are those of the VTE Prevention Simplified experts. Different policies/dosing for weight categories exist in hospitals across Canada. Again, the templates supplied can be modified/ adjusted to conform with hospital policy. sc: subcutaneously
Speakers Notes: Example of an opt-out clinical order set with prophylaxis embedded. This “box” is supplied electronically and can be embedded into any hospital order set.
Speakers Notes: Importantly, the expert committee believes that all medical and surgical patients should receive thromboprophylaxis as they are all at risk. However, there are precautions and contraindications that may alter time of dosing or type of thromboprophylaxis.
Speakers Notes: These contraindications are specific to innohep ® . This is not a complete list. Reference: innohep ® Product Monograph. Leo Pharma Inc, February 2011.
Speaker Notes: Implementation of a VTE prophylaxis policy includes raising awareness of VTE risks amongst healthcare workers and patients. It is important that dissemination of the information be done by multiple methods to reach the greatest number of healthcare professionals. To assist with implementation this slide deck as well as a shorter version have been developed to increase staff awareness. Posters for healthcare professionals and patients have also been developed to raise awareness and keep VTE prophylaxis top of mind. Examples of how to spread the word: Grand Rounds In-service sessions Posters for medical staff rooms Patient awareness and education Please note that the audit material is reviewed in a separate slide deck.