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Venous Thromboembolism Management-Nursing Inservice

As part of my cardiovascular rotation, I prepared an inservice for the nurses in the out-patient anticoagulant clinic outlining the treatment of acute VTE and extended therapy options. This was in line with one of my rotation goals to provide inter-professional teaching. The team in the anticoagulation clinic is extremely knowledgable and I wanted to demystify any lingering questions. In many cases, these questions revolved around patient inquiries regarding the duration of therapy and the necessity of warfarin bridging (5days total warfarin treatment and 2 consecutive  INRs within therapeutic range).  The use of fondaparinux in heparin induced thrombocytopenia (HIT) was another hot interest of discussion and I had to exercise caution when explaining how it was the synthetic pentasaccharide sequence of heparin and safer to use in instances of HIT…I have learned that unnecessary jargon is the fastest way to loose an audience especially when interacting with a different health care professional team with a different knowledge base. This inservice gave me a better appreciation for the knowledge relevant to nurses and allowed me to tailor the presentation to the nursing staff on the cardiovascular intensive care unit (CCU).

Unfractionated heparin and some of the IV administered anticoagulants were not agents employed in the outpatient anticoagulant clinic however these were used in various contexts in the CCU setting. These were not addressed in this presentation as it focused on VTE treatment in the out-patient anticoagulant however this presented a learning opportunity which will likely be important in my ICU rotation.

Below are my prepared table for VTE treatment as well as a simplified presentation which allowed me to work through each drug and drug target in hopes the the coagulation cascade would appear less overwhelming.

Acute Treatment of VTE_ Anticoagulant Clinic Therapy Table in the Outpatient ATC_ Clinic Nursing Inservice

Clotting Cascade Supplemental to Anticoagulant Nursing Inservice

One of aspect that I did touch on during the nursing in-services was a little off topic but an issue that I personally feel strongly about. Each of us is responsible for medication safety and I believe the nursing places a key role in preventing medication errors and so more eduction can never hurt. Currently there is a debate between the nomenclature between NOACs (new oral anticoagulants) and DOACs (direct oral anticoagulants) because they are not “new” any more blah, blah…to me these arguments are semantic in nature and I honestly should care more about this, but I don’t (sorry to all my preceptors and mentors that feel differently). To me it gained importance when it became a matter of patient safety. Read the following physician note, quickly jotted down with the best of intentions:

“Stop warfarin, NOAC”

What does this say to you when you read it? 9/10 healthcare practitioners read the same thing. “Stop warfarin, no ac (anticoagulation)” rather that the intended “stop warfarin and begin a NOAC.” I was not directly involved in this patient’s care however I was sad to learn he died shortly in hospital from an embolic stroke. For this reason, I urge others to refer to this class of medications as DOACs if the abbreviation must be made.


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