title: Implementation of vertical clinical pharmacist service on venous thromboembolism prophylaxis in hospitalized medical patients.
abstract: OBJECTIVE
  To describe the vertical clinical pharmacist service's interventions in prevention of venous thromboembolism.
  
  
  METHODS
  This prospective study was done at a private hospital. From January to May 2012, the clinical pharmacist evaluated medical patients without prophylaxis for thromboembolism. If the patient fulfilled criteria for thromboembolism and did not have contraindications, the clinical pharmacist suggested inclusion of pharmacologic agents and/or mechanical methods for venous thromboembolism prevention. In addition, the appropriate dose, route of administration, duplicity and replacement of the drug were suggested.
  
  
  RESULTS
  We evaluated 9,000 hospitalized medical patients and carried out 77 pharmaceutical interventions. A total of 71 cases (92.21%) adhered to treatment so that non-adherence occurred in 6 cases (7.79%). In 25 cases pharmacologic agents were included and in 20 cases mechanical prophylaxis. Dose adjustments, route, frequency, duplicity and replacement made up 32 cases.
  
  
  CONCLUSIONS
  The vertical clinical pharmacist service included the prophylaxis for venous thromboembolism and promotion of appropriate use of medicines in the hospital.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Celina Setsuko
authors.initials: CS
authors.lastname: Haga
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Cassio Massashi
authors.initials: CM
authors.lastname: Mancio
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Micheline da Costa
authors.initials: Mda C
authors.lastname: Pioner
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Fabricia Aparecida de Lima
authors.initials: FA
authors.lastname: Alves
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Andreia Ramos
authors.initials: AR
authors.lastname: Lira
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: João Severino da
authors.initials: JS
authors.lastname: Silva
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Fábio Teixeira
authors.initials: FT
authors.lastname: Ferracini
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Wladimir Mendes
authors.initials: WM
authors.lastname: Borges Filho
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: João Carlos de Campos
authors.initials: JC
authors.lastname: Guerra
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Claudia Regina
authors.initials: CR
authors.lastname: Laselva
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D001938:Brazil; D019983:Guideline Adherence; D006760:Hospitalization; D016304:Hospitals, Private; D006801:Humans; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
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