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Purpose: To develop a process in which clinical pharmacists would communicate suitability of rivaroxaban thromboprophylaxis in patients undergoing elective hip/knee surgery.
Methods: A procedure and a communication form were produced from analysis of inclusion and exclusion criteria from clinical trials as well as information from the drug monograph. Clinical pharmacists would review the patient’s chart one day before their scheduled operation. Creatinine clearance would be calculated using Crockoft-Gault, medications were assessed and the communication form was completed giving clear direction to the orthopedic surgeon in regards to the suitability of rivaroxaban. This communication form listed criteria for absolute and relative contraindications. If a patient had any one absolute contraindication or two relative contraindications, the patient was deemed to not be a suitable candidate for rivaroxaban thromboprophylaxis. Otherwise, the surgeon was given the choice to order rivaroxaban.
Results: The communication form was (and is) well received by the orthopedic surgeon. The clinical pharmacists would identify about one patient out of ten who would not be a candidate for rivaroxaban therapy. The involvement of the pharmacist improved trust in the proper and safe prescribing of a new oral thromboprophylactic agent. This level of trust as well as anecdotal evidence that there were no more than usual bleeding events, or venous thromboembolism, led the other three orthopedic surgeons to change their choice of thromboprophylaxis.
Conclusion: A process that involves clinical pharmacists as the central figure in directing orthopedic surgeons to prescribe a new oral thromboprophylactic agent for patients undergoing elective hip/knee replacement is beneficial. There is improved collaboration amongst surgeons and pharmacists. Anecdotally, there is no appreciable difference in bleeding or VTE events.