Image: Appropriate prescribing and monitoring of oral and intravenous anticoagulants is essential, particularly in older adult patients.
Contact
Laurie Jacobs, MD
Chief, Einstein-Montefiore Division of Geriatrics
lajacobs@montefiore.org
Strategy
Anticoagulants are commonly prescribed to deter clotting related to venous thromboembolic disease (DVT and PE), cardiac disease (atrial fibrillation, valvular disease, etc) and other systemic disease. Oral anticoagulants are widely used in older adults; however, these patients have been found to have both a greater risk for clotting as well as for bleeding in response to these medications. Appropriate prescribing and monitoring is essential.
Following a detailed analysis of anticoagulant prescribing patterns for older adult patients in hospitals and clinics throughout the Montefiore network, Dr. Jacobs developed a detailed anticoagulation therapy patient care manual based upon the ACCP guidelines. The manual details dosing and monitoring suggestions (including drug-drug and drug-food interactions) for managing patients treated with heparin, low molecular weight heparins, fondaparinux, and warfarin. Intended to advise and support practicing physicians in the judicious use of oral anticoagulants, the manual is distributed throughout Montefiore Medical Center and available online on the Montefiore intranet and via the Portal of Geriatric Online Education (www.pogoe.org).
Future Direction
Information gathered from Jacobs' research is currently being used to support development of an online decision support system for venous thrombosis prevention.