Improved Venous Thromboembolism Prophylaxis in Renal–Impaired Patients

In a study, published in the European Journal of Hospital Pharmacy, researchers examined the impact of a clinical pharmacist intervention on improving the prescribing of venous thromboembolism (VTE) prophylaxis in hospitalized patients with renal impairment (RI).

Researchers Dr. Naemeh Nikvarz and Dr. Zahra Seyedi, from the Faculty of Pharmacy and Pharmaceutical Sciences at the Kerman University of Medical Sciences in Kerman, Iran, observed that a clinical pharmacist using risk assessment models (RAMs) can improve the amount of VTE prophylaxis prescribed in hospitalized patients with RI who have a high risk of developing VTE.

The study was conducted at the authors’ center’s nephrology ward. The investigators used the Caprini RAM, Padua Prediction Score, and IMPROVE Bleeding Risk Score tools to estimate hospitalized patients’ risk for VTE and bleeding, and the rate of VTE prophylaxis administered both before and after the pharmacist’s intervention.

In their pre-intervention testing, the investigators reported that only 34.8% of high-VTE-risk patients, of which 12.5% also had a high bleeding risk, were administered pharmacological VTE prophylaxis. Conversely, 22.2% of low-risk patients received VTE prophylaxis.

After implementing the pharmacist’s intervention, all patients with high risk—and 3.3% of low-VTE-risk patients—received VTE prophylaxis. Specifically, 7% of patients with risk of both VTE and bleeding received mechanical VTE prophylaxis while the rest received heparin.

Dr. Nikvarz and Dr. Seyedi ultimately concluded that an intervention by a clinical pharmacist with implementation of the Caprini, Padua, and IMPROVE RAMs was effective for identifying the optimal patients to prescribe venous thromboembolism prophylaxis while also reducing the amount administered to low-risk patients.