Patients with active cancer are at an increased risk of arterial and venous thromboembolism (VTE) and bleeding events. Until recently, low molecular weight heparins (LMWH) were generally the preferred therapeutic class for treatment of VTE in patients with cancer. However, LMWH use is limited in the outpatient setting by parenteral administration. Recently, direct oral anticoagulants (DOACs) have demonstrated efficacy in large randomized clinical trials of patients with both VTE and atrial fibrillation and are recommended over warfarin in certain populations. Given the attractive oral dosing option and lack of laboratory montioring, DOAC use have been used for VTE treatment for patients with cancer. In this blog, we summarize the available trial data and provide clinical recommendations for VTE treatment in patients with cancer.
When it comes to triple therapy, the totality of the evidence strongly suggests “less is more”. While many practitioners have been quick to adopt dual antithrombotic therapy, it is important to consider the external validity of these trials and how we apply them to our patients. In this blog, Dr. Noel offers 3 considerations that require careful reflection before throwing in the towel on triple therapy.
Although guidelines for the management of atrial fibrillation advocate for anticoagulation in patients with a high stroke risk (CHA2DS2-VASc score of 2 or greater), the recommendations for patients at low (CHA2DS2-VASc 0) and in particular intermediate (CHA2DS2-VASc 1) risk of stroke are less clear. In this blog, we discuss antithrombotic strategies in these latter two subgroups.
Anticoagulants account for 5-10% of drug errors that occur in the hospital. Part 2 of this 2-part series on anticoagulation safety will focus on the role of anticoagulation stewardship, including what it entails, who is involved, and why it is important.
Anticoagulants are some of the most commonly implicated drugs in emergency department visits and hospitalizations due to adverse drug events. Medication errors can significantly influence these events, and pharmacists are at the forefront for preventing medication errors from reaching the patient. Part 1 of this 2 part series on anticoagulation safety will focus on common medication errors involving direct oral anticoagulants. Part 2 will focus on ways pharmacists can help prevent medication errors with anticoagulants, particularly as it relates to anticoagulation stewardship programs.