From the Guidelines
Patients on Dabigatran (Dapt) do not require additional Deep Vein Thrombosis (DVT) prophylaxis as inpatients, as the use of direct oral anticoagulants during hospitalization is generally not recommended. The American Society of Hematology 2018 guidelines for management of venous thromboembolism suggest against the use of direct oral anticoagulants during hospitalization, implying that Dabigatran provides sufficient prophylaxis [ 1 ].
Key Considerations
- The guidelines provide strong recommendations for pharmacological VTE prophylaxis in acutely or critically ill inpatients at acceptable bleeding risk, but specifically advise against the use of direct oral anticoagulants during hospitalization [ 1 ].
- Mechanical prophylaxis is recommended when bleeding risk is unacceptable, but this does not apply to patients already on Dabigatran, as they are already receiving anticoagulation therapy [ 1 ].
- The decision to provide DVT prophylaxis should be individualized based on the patient's risk factors, but the guidelines suggest that direct oral anticoagulants are sufficient for inpatient prophylaxis [ 1 ].
Management Approach
- Patients on Dabigatran should be monitored for signs and symptoms of venous thromboembolism, as well as bleeding complications.
- Regular reassessment of thrombosis and bleeding risks throughout the hospital stay is important to ensure appropriate management.
- If the patient's condition changes, or if new risk factors are introduced, the need for additional DVT prophylaxis should be reevaluated.
From the Research
DVT Prophylaxis in Patients on Dabigatran
- The provided studies do not directly address whether patients on Dabigatran (Dapt) require Deep Vein Thrombosis (DVT) prophylaxis as inpatients 2, 3, 4, 5, 6.
- However, the studies suggest that DVT prophylaxis is important for hospitalized patients at risk of venous thromboembolism (VTE), including those with malignancies 3 and medical inpatients 4, 5.
- The use of anticoagulant prophylaxis has been shown to reduce the risk of asymptomatic DVT in at-risk hospitalized medical patients, but is associated with an increased risk of major bleeding 6.
- The decision to use DVT prophylaxis in patients on Dabigatran should be based on an individualized assessment of the patient's risk factors for VTE and bleeding 2, 5.
Risk Assessment and Prophylaxis
- The Padua Risk Assessment Model (RAM) and the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Bleeding Risk Assessment Model can be used to stratify patients' risks of DVT and bleeding 5.
- A pharmacist-driven DVT Risk Alert Tool (DRAT) has been shown to improve the appropriateness of DVT prophylaxis prescribing in medical inpatients 5.
- The implementation of clinical pharmacists' prepared protocols and guidelines can also help improve the administration of DVT prophylaxis in patients 4.