Implementing Best Practices for Blood Management ….ppt

* The remainder of the black box warning is detailed on this slide. * Strategies to prevent DVT and PE should include both nonpharmacologic approaches, such as the use of intermittent pneumatic compression and graduated compression elastic stockings, and pharmacologic approaches. For prevention and treatment of VTE, low-molecular-weight heparin (LMWH) is presently the standard of care. Current recommendations for thromboprophylaxis in general surgery, orthopedic surgery, trauma, abdominal surgery, spinal cord surgery, and medical conditions include a combination of LMWH (or, in some cases, unfractionated heparin) and warfarin, used in combination with nonpharmacologic approaches. However, limitations to these approaches include a narrow therapeutic window, lack of oral bioavailability, and variable dose response. This has led to the development of newer agents. One of the new anticoagulants, fondaparinux, has been found more effective than enoxaparin in the prevention of VTE in hip fracture surgery. The direct thrombin inhibitors hirudin, bivalirudin, argatroban, and the investigational agent ximelagatran are not approved for use in VTE prophylaxis or treatment; however, they are being studied in this capacity and may prove effective. * CMS proposed that ESA treatment is not reasonable and necessary for the following conditions: Any anemia in cancer or cancer treatment patients due to folate deficiency, B12 deficiency, iron deficiency, hemolysis, bleeding, or bone marrow fibrosis Anemia of myelodysplasia Anemia of myeloid cancers Anemia associated with the treatment of myeloid cancers or erythroid cancers Anemia of cancer not related to cancer treatment Anemia associated with radiotherapy Prophylactic use to prevent chemotherapy-induced anemia Prophylactic use to reduce tumor hypoxia Patients with erythropoietin-type resistance due to neutralizing antibodies Patients with treatment regimens including anti-angiogenic drugs such as