Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism.

Venous thromboembolism (VTE) is a serious and often fatal medical condition with an increasing incidence. Despite the changing landscape of VTE treatment with the introduction of the new direct oral anticoagulants many uncertainties remain regarding the optimal use of traditional parenteral agents. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. This specific chapter addresses the practical management of heparins including low molecular weight heparins and fondaparinux. For each anticoagulant a list of the most common practice related questions were created. Each question was addressed using a brief focused literature review followed by a multidisciplinary consensus guidance recommendation. Issues addressed included initial anticoagulant dosing recommendations, recommended baseline laboratory monitoring, managing dose adjustments, evidence to support a relationship between laboratory tests and meaningful clinical outcomes, special patient populations including extremes of weight and renal impairment, duration of necessary parenteral therapy during the transition to oral therapy, candidates for outpatient treatment where appropriate and management of over-anticoagulation and adverse effects including bleeding and heparin induced thrombocytopenia. This article concludes with a concise table of clinical management questions and guidance recommendations to provide a quick reference for the practical management of heparin, low molecular weight heparin and fondaparinux

A catalog of bright calibrator stars for 200-meter baseline near-infrared stellar interferometry

We present in this paper a catalog of reference stars suitable for calibrating infrared interferometric observations. In the K band, visibilities can be calibrated with a precision of 1% on baselines up to 200 meters for the whole sky, and up to 300 meters for some part of the sky. This work, extending to longer baselines a previous catalog compiled by Borde et al. (2002), is particularly well adapted to hectometric-class interferometers such as the Very Large Telescope Interferometer (VLTI, Glindemann et al. 2003) or the CHARA array (ten Brummelaar et al. 2003) when observing well resolved, high surface brightness objects (K<8). We use the absolute spectro-photometric calibration method introduced by Cohen et al. (1999) to derive the angular diameters of our new set of 948 G8--M0 calibrator stars extracted from IRAS, 2MASS and MSX catalogs. Angular stellar diameters range from 0.6 mas to 1.8 mas (median is 1.1 mas) with a median precision of 1.35%. For both the northern and southern hemispheres, the closest calibrator star is always less than 10 degree away.Comment: 9 pages, 7 figures, submitted to A&A. The full catalog can be found in http://calys.obspm.fr/~merand/Files/MerandEtAlCatalogue.tx

Pharmacology of anticoagulants used in the treatment of venous thromboembolism

The Author(s) 2016. This article is published with open access at Springerlink.com Abstract Anticoagulant drugs are the foundation of therapy for patients with VTE. While effective therapeutic agents, anticoagulants can also result in hemorrhage and other side effects. Thus, anticoagulant therapy selection should be guided by the risks, benefits and pharmacologic characteristics of each agent for each patient. Safe use of anticoagulants requires not only an in-depth knowledge of their pharmacologic properties but also a comprehensive approach to patient management and education. This paper will summarize the key pharmacologic properties of the anticoagulant agents used in the treatment of patients with VTE

Delivery of Optimized Inpatient Anticoagulation Therapy: Consensus Statement from the Anticoagulation Forum

OBJECTIVE: To provide recommendations for optimized anticoagulant therapy in the inpatient setting and outline broad elements that need to be in place for effective management of anticoagulant therapy in hospitalized patients. The guidelines are designed to promote optimization of patient clinical outcomes while minimizing the risks for potential anticoagulation-related errors and adverse events. STUDY SELECTION AND DATA EXTRACTION: Because of this document’s scope, the medical literature was searched using a variety of strategies. When possible, recommendations are supported by available evidence; however, because this paper deals with processes and systems of care, high-quality evidence (eg, controlled trials) is unavailable. In these cases, recommendations represent consensus opinion of all authors and are endorsed by the Board of Directors of The Anticoagulation Forum, a organization dedicated to optimizing anticoagulation care. The Board is composed of physicians, pharmacists, and nurses with demonstrated expertise and experience in the management of patients receiving anticoagulation therapy. DATA SYNTHESIS: Recommendations for delivering optimized inpatient anticoagulation therapy were developed collaboratively by the authors and are summarized in eight key areas: (1) process, (2) accountability, (3) integration, (4) standards of practice, (5) provider education and competency, (6) patient education (7) care transitions, (8) outcomes. Recommendations are intended to inform the development of coordinated care systems containing elements with demonstrated benefit in improvement of anticoagulation therapy outcomes. Recommendations for delivering optimized inpatient anticoagulation therapy are intended to apply to all clinicians involved in the care of hospitalized patients receiving anticoagulation therapy. CONCLUSIONS: Anticoagulants are high-risk medications associated with a significant rate of medication errors among hospitalized patients. Several national organizations have introduced initiatives to reduce the likelihood of patient harm associated with the use of anticoagulants. Healthcare organizations are under increasing pressure to develop systems to assure the safe and effective use of anticoagulants in the inpatient setting. This document provides consensus guidelines for anticoagulant therapy in the inpatient setting and serves as a companion document to prior guidelines relevant for outpatients