Nurses play a vital role in thromboprophylaxis
Nurses are crucial to patient
safety and patient outcomes throughout the continuum of care. For patients
at risk of deep vein thrombosis (DVT), they are literally the first line of defense. DVT prophylaxis has
been cited as the single best strategy to reduce the risk of DVT in hospitals. Yet
studies have found that overall compliance with quality measures and guidelines
needs to improve.
"To close the gap that exists between evidence-based guidelines and reported prophylaxis
patterns in current clinical practice, it is essential that all healthcare professionals
understand the risk factors for VTE [venous thromboembolism] development, consistently identify patients
who are at risk, and take the necessary steps to reduce that risk."36
— Guidelines from the Case Management Society of America (CMSA) for improving
patient adherence to DVT medication therapies
Continuing Steps features a wide range of proven, practical, and diverse
resources your hospital can use to support and enhance their own deep vein thrombosis/pulmonary embolism (DVT/PE) management
programs and strategies. Continuing Steps focuses on appropriate prophylaxis
and treatment of DVT/PE, as well as management of acute coronary syndrome (ACS). Visit
www.ContinuingSteps.com for example-based tools and resources that help healthcare professionals take
action against DVT/PE and ACS in at-risk patients.
Designed to educate healthcare professionals about optimizing patient outcomes,
incorporating quality measures and guidelines, and reducing overall costs of care,
DVT Aware Care
is a customizable program for healthcare institutions of all sizes. Visit www.DVTAwareCare.com.
Our Helpful
Web sites page offers access to a wide variety of Web sites with additional information
on DVT, PE, ACS, and related topics.
Find ways to improve patient compliance and safety in DVT Case Management.
Continuum of Care
provides a resource to help with the safe transition of care from admission, through
hospitalization and follow-up care.
Important Safety Information
WARNING: SPINAL/EPIDURAL HEMATOMAS
When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is employed,
patients anticoagulated or scheduled to be anticoagulated with low-molecular-weight
heparins or heparinoids for prevention of thromboembolic complications are at risk
of developing an epidural or spinal hematoma, which can result in long-term or permanent
paralysis.
The risk of these events is increased by the use of indwelling epidural catheters
for administration of analgesia or by the concomitant use of drugs affecting hemostasis,
such as nonsteroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, or other
anticoagulants. The risk also appears to be increased by traumatic or repeated epidural
or spinal puncture.
Monitor patients for signs and symptoms of neurological impairment. If neurologic
compromise is noted, urgent treatment is necessary.
Consider the potential benefit versus risk before neuraxial intervention in patients
anticoagulated or to be anticoagulated for thromboprophylaxis (see Warnings and Precautions [5.1] and Drug Interactions [7]).
LOVENOX® (enoxaparin sodium injection) cannot be used interchangeably with other
low-molecular-weight heparins or unfractionated heparin (UFH), as they differ in
their manufacturing process, molecular weight distribution, anti-Xa and anti-IIa
activities, units, and dosage.
As with other anticoagulants, use with extreme caution in patients with conditions
that increase the risk of hemorrhage. Dosage adjustment is recommended in patients
with severe renal impairment. Unless otherwise indicated, agents that may affect
hemostasis should be discontinued prior to LOVENOX® therapy. Bleeding can occur
at any site during LOVENOX® therapy. An unexplained fall in hematocrit (HCT)
or blood pressure should lead to a search for a bleeding site. (See
WARNINGS and
PRECAUTIONS.)
In the ST-segment elevation myocardial infarction (STEMI) pivotal trial, the rates
of major hemorrhages (defined as requiring 5 or more units of blood for transfusion,
or 15% drop in HCT or clinically overt bleeding, including intracranial hemorrhage
[ICH]) at 30 days were 2.1% in the LOVENOX® group and 1.4% in the UFH group.
The rates of ICH at 30 days were 0.8% in the LOVENOX® group and 0.7% in the
UFH group. The 30-day rate of the composite endpoint of death, myocardial infarction
(MI), or ICH (a measure of net clinical benefit) was significantly lower in the
LOVENOX® group (10.1%) as compared to the UFH group (12.2%).
Thrombocytopenia can occur with LOVENOX®. In patients with a history of heparin-induced
thrombocytopenia (HIT), LOVENOX® should be used with extreme caution. Thrombocytopenia
of any degree should be monitored closely. If the platelet count falls below 100,000/mm
3,
LOVENOX® should be discontinued. Cases of HIT have been observed in clinical
practice. (See
WARNINGS and
PRECAUTIONS.)
The use of LOVENOX® has not been adequately studied for thromboprophylaxis in
pregnant women with mechanical prosthetic heart valves. (See
WARNINGS and
PRECAUTIONS.)
LOVENOX® is contraindicated in patients with hypersensitivity to enoxaparin
sodium, heparin, or pork products, and in patients with active major bleeding.
For more information, contact your local sanofi-aventis U.S. Representative or call
sanofi-aventis U.S. Medical Information Services at 1-800-633-1610.
Please see full
Prescribing Information including boxed
WARNING.
Prescription LOVENOX® is available in pharmacies.
