Clinical Outcomes and Adherence to Guideline Recommendations During the Initial Treatment of Acute Venous Thromboembolism

Background: Adherence to American College of Chest Physicians (CHEST) guidelines for treatment of acute venous thromboembolism (VTE) has not been formally assessed in the United States, specifically in the subset of patients with renal impairment. Objective: Evaluate adherence to CHEST VTE treatment...

Full description

Saved in:
Bibliographic Details
Published in:The Annals of pharmacotherapy 2015-08, Vol.49 (8), p.869-875
Main Authors: Martinez, Kerri, Kosirog, Emily, Billups, Sarah J., Clark, Nathan P., Delate, Thomas, Witt, Daniel M.
Format: Article
Language:English
Subjects:
Acute Disease
Aged
Anticoagulants - therapeutic use
Female
Guideline Adherence
Hemorrhage - chemically induced
Humans
International Normalized Ratio
Male
Middle Aged
Practice Guidelines as Topic
Recurrence
Renal Insufficiency - complications
Retrospective Studies
United States
Venous Thromboembolism - complications
Venous Thromboembolism - drug therapy
Warfarin - therapeutic use
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background: Adherence to American College of Chest Physicians (CHEST) guidelines for treatment of acute venous thromboembolism (VTE) has not been formally assessed in the United States, specifically in the subset of patients with renal impairment. Objective: Evaluate adherence to CHEST VTE treatment guidelines. Methods: This retrospective cohort study evaluated patients with acute VTE between January 1, 2010, and December 31, 2011, for the primary outcome of adherence to CHEST VTE treatment guidelines defined as (1) patients receiving an appropriate parenteral anticoagulant and dose based on renal function and weight, (2) at least 5 days of parenteral anticoagulation during warfarin initiation, and (3) an international normalized ratio (INR) value ≥2 documented before discontinuing parenteral agents. Secondary outcomes included recurrent thromboembolism and major bleeding across renal function categories. Results: Of the 1683 patients included in the final analysis, 1483 (88%) had complete data for all 3 elements of the primary outcome (dose, overlap duration, and INR ≥2.0). VTE guideline adherence was identified in 95% (1408/1483) of these patients. There were 20 major bleeds overall, which occurred in 1.1%, 1.1%, and 1.3% in patients with CrCl
ISSN:1060-0280
1542-6270
DOI:10.1177/1060028015583892