title: Clinical and management challenges in preventing venous thromboembolism in health systems: a case-based panel discussion.
abstract: OBJECTIVE
  To illustrate clinical and management issues in the prevention of venous thromboembolism (VTE) in health systems.
  
  
  CONCLUSIONS
  Lack of evidence to guide the choice among available anticoagulants and the dosing, timing of initiation, and duration of therapy for VTE prevention in certain clinical situations can present challenges for clinicians. Patient characteristics such as the presence of obesity, epidural catheters, renal impairment, or heparin- induced thrombocytopenia complicate the decision-making process. The introduction of new anticoagulants may overcome some of the clinical challenges associated with VTE prophylaxis, but determining whether to add new agents to the formulary and restrict their use may pose management challenges. The safety, effectiveness, ease of use, and cost of new agents compared with older agents already on the formulary are primary considerations.
  
  
  CONCLUSIONS
  An understanding of the clinical and management issues involved in preventing VTE is needed to improve the use of anticoagulants and reduce the incidence of VTE in health systems.
authors.affiliation: University of Maryland School of Pharmacy, Baltimore, MD, USA. shaines@rx.maryland.edu
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Haines
authors.forename: William E
authors.initials: WE
authors.lastname: Dager
authors.forename: Toby C
authors.initials: TC
authors.lastname: Trujillo
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D050110:Bariatric Surgery; D003110:Colonic Neoplasms / Q000601:surgery; D017985:Dalteparin / Q000627:therapeutic use; D005260:Female; D000077425:Fondaparinux; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery; D019990:Perioperative Care; D010607:Pharmacy Service, Hospital; D011134:Polysaccharides / Q000009:adverse effects / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000517:prevention & control* / Q000628:therapy*
chemical_list: D000925:Anticoagulants; D011134:Polysaccharides; D000077425:Fondaparinux; D017985:Dalteparin