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Alison Warren is lead cardiac pharmacist, Brighton
and Sussex University Hospitals NHS Trust |
Mike Wyndham
Oral therapy with a vitamin K antagonist, usually
warfarin, is the
treatment of choice for patients with venous thromboembolism |
SUMMARY
Treatment of suspected or confirmed venous thromboembolism (VTE) involves
the use of anticoagulant therapy such as heparin, low molecular weight
heparin or oral vitamin K antagonists to prevent further clot development
and to reduce the risks of mortality and recurrent VTE. For most patients,
treatment of deep vein thrombosis (DVT) consists of the same treatment
regimens as treatment of pulmonary embolism (PE). In certain circumstances
in the management of PE, thrombolytic therapy may be employed to break
down the existing clot or interventional procedures may be required (such
as thrombectomy or the use of inferior vena cava filters).
The pharmacological agents used in the treatment of VTE are all considered
to be “high risk” drugs. The National Patient Safety Agency
is undertaking a stakeholder consultation on the safe use of anticoagulants
and is due to issue guidance later this year. In the consultation document
the NPSA has identified several high-risk
areas, including staff competency, training, guidelines, communication
and patient information. Pharmacists in both primary and secondary care
are in key positions to use their skills to improve patient safety in
the management of patients on anticoagulant therapy.
Prophylaxis of venous thromboembolism (thromboprophylaxis) is an important
part of the care of patients at risk. Identification of those who are
at risk of developing VTE and implementation of prevention strategies
are important and are increasingly being recognised as they can reduce
the incidence of VTE and consequent mortality and morbidity.
The House of Commons Health Select Committee recommends that each NHS
trust establishes a multidisciplinary thrombosis committee with the aim
of reducing the number of patients who die from VTE every year. This
is regarded as a high priority within the NHS and pharmacists are ideally
placed to become key members of such committees. VTE guidance from the
National Institute for Health and Clinical Excellence is due to be published
in 2007 and will help support this initiative.
This article, the second part of a special feature on VTE, will outline
the main drugs used in the treatment and prevention of the condition.
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Hospital Pharmacist