In this episode, I’ll discuss when prophylactic anticoagulation, is not prophylactic anticoagulation.
When clinicians refer to prophylactic levels of anticoagulation in hospitalized patients, this usually refers to doses of anticoagulants that are meant to prevent venous thromboembolism such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Both enoxaparin and heparin have in their prescribing information FDA approval to be used for “prophylaxis of venous thromboembolism.”
Prophylactic doses of enoxaparin are usually 40 mg subcutaneously daily or 30 mg every 12 hours, and prophylactic doses of heparin are usually 5,000 units subcutaneously 2 or 3 times daily.
However, to a cardiologist, “prophylactic anticoagulation” may refer to what is usually thought of by most others as full-dose anticoagulation. This is because when a cardiologist thinks about prophylactic anticoagulation, it is usually in the context of a patient with atrial fibrillation who requires anticoagulation for the prevention (or prophylaxis) of stroke.
Confusion surrounding what is being prevented by the use of prophylactic anticoagulation could result in either under or over-dosing the level of anticoagulation.
Hospital pharmacists should be alert to the potential confusion of the term prophylactic anticoagulation, and whether its use refers to preventing VTE or preventing stroke in a patient with afib.
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