Category: Fellows Posters
Purpose: Historically, acute venous thromboembolism (VTE), including deep vein thrombosis (DVT) or pulmonary embolism (PE), has been treated with parenteral anticoagulants, such as unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Recent data has demonstrated equivalent efficacy and reduced bleeding risk with the direct acting oral anticoagulants (DOACs) apixaban and rivaroxaban. Additionally, the current potential shortage of heparin due to supply interruptions may necessitate alternative anticoagulants. The objective of this research is to provide an evidence-based treatment algorithm for utilizing DOACs in the initial management of acute VTE for our health system.
Methods: We will develop a VTE treatment algorithm that incorporates the use of DOACs for initial VTE treatment. This will be implemented as an order set in our computerized electronic medical record, Meditech. We will educate and encourage providers to use apixaban or rivaroxaban as initial therapy of VTE when clinically appropriate. Patients who have been started on a parenteral anticoagulant for acute VTE will be evaluated. A pharmacist will intervene and recommend switching to apixaban or rivaroxaban if the patient is an appropriate candidate for DOAC therapy. The study will include adult patients, age 18 or older, with an objectively confirmed diagnosis of acute VTE. Data will be collected in two phases, retrospective and prospective. Retrospective data, three months prior to initiating the order set, and prospective data from December 1st, 2019 to March 1st, 2020 will be collected. The primary outcomes will be the number of patients diagnosed with acute VTE who receive initial treatment with apixaban or rivaroxaban versus those who receive parenteral anticoagulants, in addition to the number of patients switched to apixaban or rivaroxaban after initial treatment with a parenteral anticoagulant. Other outcome measures will include: bleeding events, length of intensive care unit (ICU) stay, length of hospital-stay, 30-day readmissions for VTE recurrence, 30-day readmission for bleeding and 30-day all –cause readmissions.