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

Evaluation of online training on the prevention of venous thromboembolism.

IntroductionThe integration of new evidence into clinical practice can be a prolonged process, with delays of years or even decades. One approach to speed this integration is through the use of online provider education.ProblemVenous thromboembolism (VTE) is a serious patient safety issue. Prevention requires coordinated care and adherence to evidence-based guidelines, supported by provider education.PurposeThis study reports how an interdisciplinary team developed and piloted an online provider training program for the prevention of VTE.HypothesisIf providers use the online educational training, they will demonstrate increased mastery of key content areas related to VTE prophylaxis.MethodsWe used a prospective test-retest study design in which medical residents and fellows served as their own controls. All participants were given a pretest followed by educational content and then a posttest. We also assessed 2 different types of learning content (ie, with and without case studies/questions) and randomized participants to each type prior to assessment.ResultsUsing the McNemar test we found a trend for knowledge gains related to VTE guidelines on the posttest for clinicians (n = 67) with a 14.5% improvement in content mastery (P = .05, 2-tailed). We did not find any significant differences between training modalities. Clinicians overall reported high levels of satisfaction with the application.ConclusionOur online education efforts indicate the potential for increasing mastery of VTE prophylaxis concepts. If resources are limited, we suggest a static approach to content delivery and an exploration of standardized methods for portability of online curriculums across learning management systems