Abstract
The prevention and management of venous thromboembolism have become increasingly important clinical issues that cross many professional and subspecialty boundaries. Better identification of risk factors, improvements in the diagnosis and treatment of thromboembolic disorders, and greatly expanded knowledge related to thromboprophylaxis have presented new challenges for the delivery of evidencebased care. Accumulating data and subsequent recommendations in this area are collected every 3 years in the American College of Chest Physicians Consensus Conference on Antithrombotic Therapy and published as a supplement to the journal Chest, 1 an issue that is widely read by interested hospital pharmacists and physicians. There are many centres of excellence in clinical thromboembolism in North America, all of which are clustered at tertiary care teaching hospitals. At the vast majority of community hospitals, thrombosis prevention and management are not the responsibility of any one practitioner but rest mainly in the hands of physicians in a variety of specialties including hematology, cardiology, internal medicine, orthopedics, and vascular surgery. Most long-term anticoagulation for ambulatory patients is managed by family physicians. Yet we believe that pharmacists are well suited to take on responsibilities in this area, and our purpose in writing this editorial is to try to expedite this transfer of responsibility from physician to pharmacist. Recent studies and surveys have shown that the application of evidence-based practice in several aspects of management of venous thromboembolism could be significantly improved. For example, thromboprophylaxis is frequently underutilized both in general medical inpatients and after high-risk abdominal surgery, whereas the reversal of warfarin overanticoagulation
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