Samuel Z. Goldhaber, MD
Professor of Medicine
Harvard Medical School
Director, Venous Thromboembolism Research Group
Co-Director, Anticoagulation Management Service
Brigham and Womenís Hospital
H. Edward Davidson, PharmD, MPH
Assistant Professor, Clinical Internal Medicine
Eastern Virginia Medical School
Editor-in-Chief, The Consultant Pharmacist
Partner, Insight Therapeutics, LLC
THIS ACTIVITY WAS ORIGINALLY PRESENTED AS A LIVE AUDIOCONFERENCE BEGINNING ON MAY 11, 2009. IF YOU RECEIVED CREDIT FOR PARTICIPATING IN THE AUDIOCONFERENCE, YOU ARE NOT ELIGIBLE TO RECEIVE CREDIT FOR THIS ONLINE ACTIVITY.
Venous thromboembolism (VTE) is the most common preventable cause of hospital death in the United States, and patients undergoing major orthopedic surgery (e.g., hip or knee arthroplasty) are among those at highest risk. Older persons who have undergone surgery increasingly receive post-hospital care in assisted living or skilled nursing facilities, or from a home-based provider. Patients requiring such care may be at an even higher risk for VTE because of their age, immobility, and/or other potential co-morbidities.
Prophylaxis has traditionally been given from the time of surgery until hospital discharge (varying with the type of procedure). Hospital stays are becoming shorter, however, and studies demonstrate that the risk for developing deep vein thrombosis (DVT) or pulmonary embolism (PE) persists long after patients are discharged. In one study, the median time to such an event was about 4 weeks after total-hip replacement and 2 weeks after knee replacement. The "at-risk" period extended for 3 months after hip surgeries and 1 month after knee surgery.
Recognizing that a significant proportion of patients develop DVT or PE well after discharge, the FDA has approved extended anticoagulation prophylaxis for patients undergoing some major orthopedic surgery. Continuity of care and extended prophylaxis following discharge to a skilled nursing or assisted living facility is likely to provide clinical benefits in these high-risk patients. Effective communication among all members of the team, in combination with efforts to assess VTE risk in orthopedic surgery patients and apply evidence-based prophylaxis guidelines can improve patient care and outcomes.
. Target Audience
This activity has been developed specifically for pharmacists involved in senior care; health system pharmacists; and nursing directors and nurses who work in assisted-living facilities, skilled nursing facilities, subacute care facilities, and home care.
Upon completion of this knowledge-based educational activity, the participant should be able to:
Review the characteristics of existing and emerging anticoagulant agents used for the prevention of VTE
Explain how existing and emerging anticoagulant agents should be utilized in the rehabilitation, skilled nursing care, and outpatient home care setting
Discuss the latest clinical practice guidelines on the prevention of VTE for patients who undergo elective hip and knee arthroplasty
Identify ways to improve the continuum of VTE prophylaxis as patients transition from one setting to another
The American Society of Consultant Pharmacists (ASCP) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity (UAN: 203-999-09-050-H01-P) was developed by ASCP and is approved for 1.0 Contact Hour (0.1 CEU).
NADONA/LTC is an approved provider of continuing nursing education by Georgia Nurses Association, an accredited approver by the American Nurses Credentialing Centerís Commission on Accreditation #1088. This activity provides 1 contact hour by NADONA/LTC.
Participants must successfully complete the post test (70% or higher) and submit an evaluation to receive credit. A statement of credit will be available immediately if the post-test and evaluation are completed online, or mailed within 4-6 weeks if they are submitted by mail.
Commercial Support Statements
Supported by an educational grant from Ortho-McNeil Inc., Division of Ortho-McNeil-Janssen Pharmaceuticals Inc., administered by Ortho-McNeil-Janssen Scientific Affairs, LLC.