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Abstract
OBJECTIVES The purpose of this article is to review the current literature on drug-induced thrombocytosis with the goal of critically assessing causality and providing a comprehensive review of the topic. Thrombopoietic growth factors, such as thrombopoietin-receptor agonists (romiplostim and eltrombopag) and erythropoietin are not included in our review. DATA SOURCES The literature search included published articles limited to the English language and humans in MEDLINE, EMBASE, and Web of Science databases. MEDLINE/PubMed (1966 to September 2018) was searched using the MeSH terms thrombocytosis/chemically-induced and thrombocytosis/etiology. EMBASE (1980 to September 2018) was searched using the EMTAGS thrombocytosis/side effect. Web of Science (1970 to September 2018) was searched using the search term thrombocytosis. References of all relevant articles were reviewed for additional citations and information. STUDY SELECTION AND DATA EXTRACTION Review articles, clinical trials, background data, case series, and case reports of drug-induced thrombocytosis were collected, and case reports were assessed for causality using a modified Naranjo nomogram. DATA SYNTHESIS Drug-induced thrombocytosis, a form of reactive thrombocytosis cannot be easily differentiated from more common etiologies of reactive thrombocytosis. In all, 43 case reports of drug-induced thrombocytosis from a wide variety of drugs and drug classes were reviewed using a modified Naranjo probability scale that included criteria specific for thrombocytosis. CONCLUSIONS Drug-induced thrombocytosis is a relatively rare adverse drug reaction. The strongest evidence of causality supports low-molecular-weight heparins and neonatal drug withdrawal. Weaker evidence exists for all-trans retinoic acid, antibiotics, clozapine, epinephrine, gemcitabine, and vinca alkaloids.
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Affiliation(s)
- Quyen T Vo
- 1 Southwestern Oklahoma State University, Weatherford, OK, USA
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Kano EK, Borges JB, Scomparini EB, Curi AP, Ribeiro E. Algorithms for monitoring warfarin use: Results from Delphi Method. ACTA ACUST UNITED AC 2018; 63:842-855. [PMID: 29267485 DOI: 10.1590/1806-9282.63.10.842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/26/2017] [Indexed: 02/08/2023]
Abstract
Warfarin stands as the most prescribed oral anticoagulant. New oral anticoagulants have been approved recently; however, their use is limited and the reversibility techniques of the anticoagulation effect are little known. Thus, our study's purpose was to develop algorithms for therapeutic monitoring of patients taking warfarin based on the opinion of physicians who prescribe this medicine in their clinical practice. The development of the algorithm was performed in two stages, namely: (i) literature review and (ii) algorithm evaluation by physicians using a Delphi Method. Based on the articles analyzed, two algorithms were developed: "Recommendations for the use of warfarin in anticoagulation therapy" and "Recommendations for the use of warfarin in anticoagulation therapy: dose adjustment and bleeding control." Later, these algorithms were analyzed by 19 medical doctors that responded to the invitation and agreed to participate in the study. Of these, 16 responded to the first round, 11 to the second and eight to the third round. A 70% consensus or higher was reached for most issues and at least 50% for six questions. We were able to develop algorithms to monitor the use of warfarin by physicians using a Delphi Method. The proposed method is inexpensive and involves the participation of specialists, and it has proved adequate for the intended purpose. Further studies are needed to validate these algorithms, enabling them to be used in clinical practice.
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Affiliation(s)
- Eunice Kazue Kano
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Jessica Bassani Borges
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Erika Burim Scomparini
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana Paula Curi
- School of Arts, Sciences and Humanities, USP, São Paulo, SP, Brazil
| | - Eliane Ribeiro
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Vilanova E, Glauser BF, Oliveira SNMCG, Tovar AMF, Mourão PAS. Update on Brazilian biosimilar enoxaparins. Expert Rev Hematol 2016; 9:1015-1021. [PMID: 27680213 DOI: 10.1080/17474086.2016.1243052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Brazil is among the first countries approving the commercialization and clinical use of biosimilar enoxaparins. Our research group has performed quality control assessments of these drugs over the last decade. Areas covered: We have not found noticeable differences between Brazilian biosimilar enoxaparins and the original product regarding their physicochemical properties, disaccharide composition, anticoagulant activity, bioavailability and safety. Expert commentary: In spite of clinical and pharmacological advantages of enoxaparin, subcutaneous formulations of unfractionated heparin are employed by the Brazilian public health system for prevention and treatment of thromboembolism. The underuse of both original and biosimilar enoxaparins in Brazil directly correlates with their high cost.
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Affiliation(s)
- Eduardo Vilanova
- a Hospital Universitário Clementino Fraga Filho and Instituto de Bioquímica Médica Leopoldo de Meis , Universidade Federal do Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Bianca F Glauser
- a Hospital Universitário Clementino Fraga Filho and Instituto de Bioquímica Médica Leopoldo de Meis , Universidade Federal do Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Stephan-Nicollas M C G Oliveira
- a Hospital Universitário Clementino Fraga Filho and Instituto de Bioquímica Médica Leopoldo de Meis , Universidade Federal do Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Ana M F Tovar
- a Hospital Universitário Clementino Fraga Filho and Instituto de Bioquímica Médica Leopoldo de Meis , Universidade Federal do Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Paulo A S Mourão
- a Hospital Universitário Clementino Fraga Filho and Instituto de Bioquímica Médica Leopoldo de Meis , Universidade Federal do Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
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Patel R. Effective management of venous thromboembolism in the community: non-vitamin K antagonist oral anticoagulants. Int J Gen Med 2016; 9:107-15. [PMID: 27217793 PMCID: PMC4862352 DOI: 10.2147/ijgm.s100299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Anticoagulation therapy is essential for the effective treatment and secondary prevention of venous thromboembolism (VTE). For many years, anticoagulation for acute VTE was limited to the use of initial parenteral heparin, overlapping with and followed by a vitamin K antagonist. Although highly effective, this regimen has several limitations and is particularly challenging when given in an ambulatory setting. Current treatment pathways for most patients with deep-vein thrombosis typically involve initial hospital or community-based ambulatory care with subsequent follow-up in a secondary care setting. With the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) into routine clinical practice, it is now possible for the initial acute management of patients with deep-vein thrombosis to be undertaken by primary care. As hospital admissions associated with VTE become shorter, primary care will play an increasingly important role in the long-term management of these patients. Although the NOACs can potentially simplify patient management and improve clinical outcomes, primary care physicians may be less familiar with these new treatments compared with traditional therapy. To assist primary care physicians in further understanding the role of the NOACs, this article outlines the main differences between NOACs and traditional anticoagulation therapy and discusses the benefit–risk profile of the different NOACs in the treatment and secondary prevention of recurrent VTE. Key considerations for the use of NOACs in the primary care setting are highlighted, including dose transition, risk assessment and follow-up, duration of anticoagulant therapy, how to minimize bleeding risks, and the importance of patient education and counseling.
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Affiliation(s)
- Raj Patel
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital, London, UK
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Dobesh PP, Trujillo TC, Finks SW. Role of the Pharmacist in Achieving Performance Measures to Improve the Prevention and Treatment of Venous Thromboembolism. Pharmacotherapy 2013; 33:650-64. [DOI: 10.1002/phar.1244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Paul P. Dobesh
- College of Pharmacy; University of Nebraska Medical Center; Omaha; Nebraska
| | - Toby C. Trujillo
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences; Aurora; Colorado
| | - Shannon W. Finks
- College of Pharmacy; University of Tennessee Health Science Center; Memphis; Tennessee
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Performance measures for improving the prevention of venous thromboembolism: achievement in clinical practice. J Thromb Thrombolysis 2012; 32:293-302. [PMID: 21667203 DOI: 10.1007/s11239-011-0605-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Venous thromboembolism (VTE) is a common complication during and after hospitalization for acute medical illness or surgery. Despite the existence of evidence-based guidelines for VTE prevention, real-world prescribing practices are frequently suboptimal. Specific performance measures relating to VTE prevention and treatment have been developed by US health care organizations to increase adherence with best-practice recommendations and ultimately reduce the number of preventable VTE events. Two measures developed by the Surgical Care Improvement Project have been endorsed by the National Quality Forum (NQF) and focus on VTE prevention. In addition, six measures have been developed recently by The Joint Commission in collaboration with the NQF; three measures relate to VTE prevention and three focus on treatment. To attain widespread achievement of these performance goals, it is essential to raise awareness of their existence and specifications. It is also imperative that hospitals develop and implement effective VTE protocols. The use of multiple, active strategies, such as computer decision support systems with regular audit and feedback, may be particularly valuable approaches to improve current practices within an integrated quality improvement program. During practical implementation of VTE protocols at Norton Healthcare (Kentucky's largest healthcare system), strong leadership, physician engagement, and caregiver accountability were identified as key factors influencing the process. As such, more hospitals may be able to increase adherence with guidelines, improve achievement of quality goals, and help to reduce the substantial burden associated with avoidable VTE.
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Zeitoun AA, Nassif JG, Zeineddine MM. The appropriateness of enoxaparin use in Lebanese hospitals: a quality evaluation study. Int J Clin Pharm 2011; 33:934-41. [PMID: 21909665 DOI: 10.1007/s11096-011-9559-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 08/29/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although, guidelines for the appropriate use of enoxaparin are published, yet the extent of their implementation in clinical practice is still questionable. Furthermore, the optimal dosing of enoxaparin in special populations such as renal insufficiency and obesity remains controversial. In the Middle East, there are insufficient data on the appropriateness of enoxaparin use in different indications. OBJECTIVE (1) To assess the appropriateness of enoxaparin dosing and duration per indication in compliance with the recommended guidelines and their impact on safety and efficacy outcomes in Lebanese health care centers. (2) To evaluate the influence of the hospital type (teaching vs. non-teaching) on the extent of compliance with established guidelines. SETTING Seventeen health care centers in Lebanon, including teaching and non-teaching hospitals. METHODS An observational, cross-sectional, multicenter study was conducted in 17 Lebanese hospitals. Data on demographics, indication, dosing regimen and clinical outcomes were collected. The appropriateness of dosing practices was determined as per the ACCP guidelines and the FDA dosing recommendations. MAIN OUTCOME MEASURE The appropriateness of enoxaparin dosing was compared across different hospital type and among special populations including severe renal insufficiency and very obese patients. RESULTS Of the 463 patients who participated in the study, 40% received improper enoxaparin dosing, which was mostly observed in the VTE prophylaxis group (41.6%, P < 0.001). When comparing the overall dosing practices in Lebanese hospitals, there was no statistically significant difference in the correctness of enoxaparin dosing between teaching and non-teaching hospitals (61.6% vs. 58.2%, P = 0.449), respectively. Only 11.5% of renally impaired patients and 59.4% of obese patients received correct doses. CONCLUSION This study highlighted the improper practice and thus the need of implementation of clinical practice guidelines for the dosing of enoxaparin, in Lebanese hospitals.
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Affiliation(s)
- A A Zeitoun
- School of Pharmacy, Pharmacy Practice Department, Lebanese American University, P.O. Box 36, Mail Box: F 74, Byblos, Lebanon.
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Tiryaki F, Nutescu EA, Hennenfent JA, Karageanes AM, Koesterer LJ, Lambert BL, Schumock GT. Anticoagulation therapy for hospitalized patients: Patterns of use, compliance with national guidelines, and performance on quality measures. Am J Health Syst Pharm 2011; 68:1239-44. [DOI: 10.2146/ajhp100543] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Funda Tiryaki
- Center for Pharmacoeconomic Research, University of Illinois at Chicago (UIC), Chicago
| | - Edith A. Nutescu
- Center for Pharmacoeconomic Research, and Antithrombosis Center, UIC
| | | | - Annette M. Karageanes
- Beaumont Hospital, Royal Oak, MI; at the time of this study, she was Clinical Resource Specialist, Pharmacy Services, Ascension Health, St. Louis, MO
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Lobo B, Finch CK, Howard-Thompson A, Gillion A. Pharmacist-Managed Direct Thrombin Inhibitor Protocol Improves Care of Patients with Heparin-Induced Thrombocytopenia. Hosp Pharm 2010. [DOI: 10.1310/hpj4509-705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of direct-thrombin inhibitors (DTIs) for the management of patients with heparin-induced thrombocytopenia (HIT) is challenging. A pharmacist-managed DTI protocol was implemented to standardize and improve the care of patients with HIT. A background study that compared DTI protocol–treated patients to those who did not receive treatment with the DTI protocol found that significantly more of the DTI protocol–treated patients received care that was consistent with level 1 guidelines from the American College of Chest Physicians (41% vs 0%). Because outcomes were poor regardless of whether the DTI protocol was used, the protocol was revised to require pharmacist implementation and oversight. A follow-up study compared DTI protocol patients from the background study (non-pharmacist-managed) to the pharmacist-managed DTI protocol group. There were significantly fewer dosing errors, improved nursing documentation, and less reexposure to heparin when the pharmacist was responsible for managing the DTI protocol. A trend toward reduced bleeding was noted. The management of patients with HIT is complex, and there are a number of pitfalls that may lead to poor outcomes. DTIs are high-risk medications that require careful dosing and monitoring to minimize risk for adverse drug events. A DTI protocol may improve care of patients with HIT, and pharmacist oversight of DTI use can help to reduce risk for errors and adverse medication events.
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Affiliation(s)
- Bob Lobo
- Department of Pharmaceutical Services, Vanderbilt University Hospital, Nashville, Tennessee
| | - Christopher K. Finch
- Methodist University Hospital, College of Pharmacy, University of Tennessee, Memphis, Tennessee
| | | | - Amanda Gillion
- Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee
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Muntz J. Duration of deep vein thrombosis prophylaxis in the surgical patient and its relation to quality issues. Am J Surg 2010; 200:413-21. [DOI: 10.1016/j.amjsurg.2009.05.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 05/12/2009] [Accepted: 05/12/2009] [Indexed: 10/19/2022]
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The eighth American college of chest physicians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies. J Thromb Thrombolysis 2010; 31:196-208. [DOI: 10.1007/s11239-010-0500-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Barras MA, Kirkpatrick CMJ, Green B. Current dosing of low-molecular-weight heparins does not reflect licensed product labels: an international survey. Br J Clin Pharmacol 2010; 69:520-8. [PMID: 20573088 PMCID: PMC2856053 DOI: 10.1111/j.1365-2125.2010.03626.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 12/15/2009] [Indexed: 12/01/2022] Open
Abstract
AIMS Low-molecular-weight heparins (LMWHs) are used globally to treat thromboembolic diseases; however, there is much debate on how to prescribe effectively for patients who have renal impairment and/or obesity. We aimed to investigate the strategies used to dose-individualize LMWH therapy. METHODS We conducted an online survey of selected hospitals in Australia, New Zealand (NZ), United Kingdom (UK) and the United States (US). Outcome measures included: the percentage of hospitals which recommended that LMWHs were prescribed according to the product label (PL), the percentage of hospitals that dose-individualized LMWHs outside the PL based on renal function, body weight and anti-Xa activity and a summary of methods used to dose-individualize therapy. RESULTS A total of 257 surveys were suitable for analysis: 84 (33%) from Australia, 79 (31%) from the UK, 73 (28%) from the US and 21 (8%) from NZ. Formal dosing protocols were used in 207 (81%) hospitals, of which 198 (96%) did not adhere to the PL. Of these 198 hospitals, 175 (87%) preferred to dose-individualize based on renal function, 128 (62%) on body weight and 48 (23%) by monitoring anti-Xa activity. All three of these variables were used in 29 (14%) hospitals, 98 (47%) used two variables and 71 (34%) used only one variable. CONCLUSIONS Dose-individualization strategies for LMWHs, which contravene the PL, were present in 96% of surveyed hospitals. Common individualization methods included dose-capping, use of lean body size descriptors to calculate renal function and the starting dose, followed by post dose anti-Xa monitoring.
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Affiliation(s)
- Michael A Barras
- School of Pharmacy, The University of QueenslandBrisbane, Queensland
- Therapeutic Advisory Service, Pharmacy Department, Mater Health ServicesBrisbane, Queensland
| | - Carl M J Kirkpatrick
- Therapeutic Advisory Service, Pharmacy Department, Mater Health ServicesBrisbane, Queensland
| | - Bruce Green
- Model Answers Pty LtdBrisbane, Queensland, Australia
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Clark P, Wu O, Greer IA, Lowe GDO. Venous thrombosis prevention - more than just guidelines. Br J Haematol 2010; 149:50-4. [DOI: 10.1111/j.1365-2141.2010.08080.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McKean SC, Deitelzweig SB, Sasahara A, Michota F, Jacobson A. Assessing the risk of venous thromboembolism and identifying barriers to thromboprophylaxis in the hospitalized patient. J Hosp Med 2009; 4:S1-7. [PMID: 19830850 DOI: 10.1002/jhm.587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sylvia C McKean
- Academic Hospitalist Service, Brigham & Women's Hospital, Boston, MA 02115, USA.
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Abstract
Venous thromboembolism (VTE) prevention has been recognized as the most important practice for improving patient safety in hospitals. To be effective, VTE prophylaxis must be appropriately prescribed with respect to type, dose and duration. Large-scale studies of medical discharge records have highlighted low rates of appropriate thromboprophylaxis in hospitalized medical patients, especially those with cancer or severe lung disease. Lack of prophylaxis and an insufficient duration are the most common forms of inappropriate prophylaxis. Multifaceted, active, quality improvement initiatives have been developed and shown to successfully increase the appropriate prescribing of VTE prophylaxis in patients at risk. By increasing the use of appropriate VTE prophylaxis in at-risk patients, the disease burden of hospital-acquired VTE and its resulting complications can be reduced.
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Affiliation(s)
- S L Cohn
- Department of Medicine, SUNY Downstate, Brooklyn, NY 11203, USA.
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Dager WE. Improving anticoagulation management in patients with atrial fibrillation. Am J Health Syst Pharm 2007; 64:2279-80. [PMID: 17959581 DOI: 10.2146/ajhp070495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- William E Dager
- School of Pharmacy, University of California San Francisco, CA, USA.
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