Background and goal: Due to the importance of anticoagulation use along with the complications that deep vein thrombosis (DVT) and pulmonary embolism (PE) may bring about for the patients, in this study we decided to carry out a drug utilization evaluation on anticoagulants that are routinely administered in a tertiary teaching hospital. Method: Anticoagulants utilization was evaluated in 400 patients from 4 wards (infectious disease, cardiology, nephrology, and cardiac care unit) of a tertiary teaching hospital in a cross-sectional, prospective study. Results: According to the risk stratification, 220 (55%) of the evaluated patients have indication to receive anticoagulants as deep venous thrombosis prophylaxis. With definite diagnosis of DVT or PE, 169 (42.3%) patients have received anticoagulant therapy. In 11 (2.8%) cases, anticoagulants has been ordered inappropriately. In assessment of the anticoagulants regimens that were used as DVT prophylaxis doses of heparin and enoxaparin were appropriate in 75% and 79% of patients, respectively. Conclusion: Despite the existence of comprehensive guidelines for the prevention and treatment of DVT and PE, it is not performed accurately.
DentaliFDouketisJDGianniM. Metaanalysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med. 2007;146(4):278–288.
2.
MismettiPLaporte-SimitsidisSTardyB. Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomized clinical trials. Thromb Haemost. 2000;83(1):14–19.
3.
GeertsWHBergqvistDPineoGF. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 suppl):381S–453S.
4.
QuinlanDJEikelboomJWDahlOE. Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery. J Thromb Haemost. 2007;5(7):1438–1443.
5.
LeizoroviczACohenATTurpieAG. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004;110(7):874–879.
6.
SamamaMMCohenATDarmonJ. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. N Engl J Med. 1999;341(11):793–800.
7.
CohenATDavidsonBLGallusAS. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomized placebo controlled trial. BMJ. 2006;332(7537):325–329.
8.
FraisseFHolzapfelLCoulaudJ. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD. Am J Respir Crit Care Med. 2000;161(4 pt 1):1109–1114.
9.
LloydNSDouketisJDMoinuddinI. Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: a systematic review and meta-analysis. J Thromb Haemost. 2008;6(3):405–414.
10.
NicolaidesANFareedJKakkarAK. Prevention and treatment of venous thromboembolism. International Consensus Statement (guidelines according to scientific evidence). Int Angiol. 2006;25(2):101–161.
11.
GoldhaberSZDunnKMacDougallRC. New onset of venous thromboembolism among hospitalized patients at Brigham and Women’s Hospital is caused more often by prophylaxis failure than by withholding treatment. Chest. 2000;118(6):1680–1684.
12.
AgenoWGrimwoodRLimbiatiS. Home-treatment of deep vein thrombosis in patients with cancer. Haematologica. 2005;90(2):220–224.
13.
KakkarAKLevineMPinedoHM. Insights from the FRONTLINE survey. Oncologist. 2003;8(4):381–388.
14.
KirwanCCNathEByrneGJ. Prophylaxis for venous thromboembolism during treatment for cancer: questionnaire survey. Br Med J. 2003;327(7415):597–598.
15.
ChopardPDörffler-MellyJHessU. Venous thromboembolism prophylaxis in acutely ill medical patients: definite need for improvement. J Intern Med. 2005;257(4):352–357.
16.
HirshJGuyattGHAlbersGW. Antithrombotic and thrombolytic therapy: ACCP Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 suppl):110S–112S.
17.
RothschildSConenD. Characteristics of bleeding complications in patients with anticoagulant treatment. Swiss Med Wkly. 2008;138(47-48):719–724.
18.
HainesSTRacineEZeollaMVenous thromboembolism. In:
DipiroJTTalbertRLYeeGCMatzkeGRWellsBGPoseyLM (Eds.), Pharmacotherapy: A Pathophysiologic Approach. 8th ed.New York, NY: McGraw-Hill; 2008.
19.
GreinacherAFarnerBKrollH. Clinical features of heparin-induced thrombocytopenia including risk factors for thrombosis: a retrospective analysis of 408 patients. Thromb Haemost. 2005;94(1):132–135.
20.
MartelNLeeJWellsPS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood. 2005;106(8):2710–2715.
21.
PrandoniPSiragusaSGirolamiB. The incidence of heparin-induced thrombocytopenia in medical patients treated with low-molecular-weight heparin: a prospective cohort study. Blood. 2005;106(9):3049–3054.
GirolamiBPrandoniPStefaniPM. The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study. Blood. 2003;101(8):2955–2959.
24.
KristinBGGeorgeMR. Utilization and outcomes of enoxaparin treatment for deep vein thrombosis in a tertiary care hospital. Am J Hematol. 2000;65(4):285–288.
25.
FahimiFBaniasadiSBehzadniaN. Enoxaparin utilization evaluation: an observational prospective study in medical inpatients. Iranian J Pharm Res. 2008;7(1):77–82.
26.
GoreJMSpencerFAGurfinkelEP. Thrombocytopenia in patients with an acute coronary syndrome (from the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol. 2009;103(2):175–180.
27.
PengoVLensingAWPrinsMH. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350(22):2257–2264.
28.
WarkentinTESheppardJASigouinCS. Gender imbalance and risk factor interactions in heparin-induced thrombocytopenia. Blood. 2006;108(9):2937–2941.
29.
DinwoodeyDLAnsellJE. Heparins, low-molecular-weight heparins, and pentasaccharides: use in the older patient. Cardiol Clin. 2008;26(2):145–155.
30.
KilickiranBAOtoAOzcebeO. Thrombocytopenia associated with antithrombotic therapy in patients with cardiovascular diseases diagnosis and treatment. Am J Cardiovasc Drugs. 2008;8(5):327–339.
