Key Concepts

0 Antithrombotic therapies require meticulous and systematic monitoring, as well as ongoing patient education. Well-organized anticoagulation management services improve the quality of patient care and reduce the overall cost.

01 The risk of venous thromboembolism (VTE) is related to several identifiable factors including age, prior history of VTE, major surgery (particularly orthopedic procedures of the lower extremities), trauma, malignancy, pregnancy, estrogen use, and hypercoagulable states. These risks are additive.

The diagnosis of VTE must be confirmed by objective testing.

At the time of hospital admission, all patients should be evaluated for their risk of VTE, and strategies to prevent VTE appropriate for each patient's level of risk should be routinely employed. Prophylaxis should be continued throughout the period of risk.

O In the absence of contraindications, the treatment of VTE should initially include a rapid-acting anticoagulant (e.g., unfractional heparin [UFH], low-molecular weight heparin [LMWH], or fondaparinux) overlapped with warfarin for at least 5 days and until the patient's International Normalized Ratio (INR) is greater than 2 and stable. Anticoagulation therapy should be continued for a minimum of 3 months. However, the duration of anticoagulation therapy should be based on the patient's risk of VTE recurrence and major bleeding.

^ Bleeding is the most common adverse effect associated with antithrombotic drugs. A patient's risk of major hemorrhage is related to the intensity and stability of therapy, age, concurrent drug use, history of GI bleeding, risk of falls or trauma, and recent surgery.

Most patients with an uncomplicated deep vein thrombosis (DVT) can be managed safely at home.

Warfarin is prone to numerous clinically important drug-drug and drug-food interactions.

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