ASHP Therapeutic Position Statement on the Role of Pharmacotherapy in Preventing Venous Thromboembolism in Hospitalized Patients

Hospitals should develop formal policies, guidelines, practices, and procedures to address the appropriate prevention of venous thromboembolism (VTE). In addition, all hospitalized patients should be assessed for risk for both VTE and bleeding to determine if pharmacologic, mechanical, or combination VTE prophylaxis should be initiated. Patients should also be reassessed following any pertinent clinical changes. In at-risk patients without contraindications (i.e., risk for bleeding, active bleeding, or allergy), pharmacologic thromboprophylaxis should be initiated as soon as possible and within the first 24 hours of arrival at the hospital. Mechanical methods should be used when pharmacologic prophylaxis is contraindicated. Active interdisciplinary, multifaceted VTE prevention programs, in contrast to passive strategies, should be used to improve appropriate VTE prophylaxis within hospitals. These programs should incorporate provider, staff, and patient education; audits and feedback; hospital guidelines and policies; clinical decisionsupport software; monitoring for appropriate anticoagulant use; and provider reminders. Guidelines and policies need to be individualized at the hospital level, depending on the degree to which pharmacy, providers, nursing, and other staff are involved. The National Quality Forum (NQF) and the Joint Commission recommend creating policies and guidelines regarding anticoagulation. This is also a key recommendation of the American College of Chest Physicians (ACCP). Pharmacy professionals should actively participate in the development, implementation, and monitoring of anticoagulation and VTE prophylaxis programs. In addition, because pharmacologic prophylaxis is the primary method to prevent VTE, pharmacy professionals should take a leadership role in these hospital programs.