Antithrombotic Therapy in the Long-Term Care Setting

Antithrombotic therapy represents the mainstay of treatment and preventive measures in patients with atherothrombotic diseases. Both the incidence and prevalence of these diseases increase with age. Patients residing in the post-acute and long-term care (PALTC) setting are highly susceptible to atheroembolic events by reason of their age and general vulnerability. Clinical decisions are challenging in this setting because of the paucity of data specific to treatment of the frail elderly and the predisposition of this patient population to adverse drug reactions.

Antithrombotic Therapy in the Long-Term Care Setting is a succinct and practical reference manual designed to fill an important void in thrombi and thromboemboli reference materials. Drawn from evidence-based and best practices this manual helps practitioners quickly find answers to questions they face every day such as:

• What is the best antiplatelet regimen to prevent myocardial infarction or ischemic stroke?
• What is the safest way to begin, titrate, and monitor warfarin therapy for a frail elderly patient?
• Which patients are at greatest risk for deep vein thrombosis (DVT), and what are the best regimens to prevent and treat DVT?
• What adjustments to antiplatelet or antithrombotic therapy are needed when a patient has an invasive procedure or major surgery?

Filled with easy to read tables, this one-of-a-kind manual includes:

• Introduction to antithrombotic therapy in the LTC setting
• Prevention of venous thromboembolism
• Treatment and secondary prophylaxis of venous thromboembolism
• Antithrombotic therapy for stroke or stroke prevention and in atrial fibrillation
• Antithrombotic therapy in cardiovascular disease
• Managing the risks of major bleeding events associated with antithrombotic therapy
• Antiplatelet agents in antithrombotic therapy
• Warfarin in antithrombotic therapy
• Other oral anticoagulants in antithrombotic therapy
• Parenteral anticoagulants in antithrombotic therapy
• Heparin-induced thrombocytopenia
• Perioperative management of antithrombotic therapy
• Ten helpful appendices

Antithrombotic Therapy in the Long-Term Care Setting Information is intended to help practitioners optimally manage the use of antithrombotic therapies in elderly patients in the PALTC setting. The manual incorporates evidence-based guidelines and expert opinion from several specialty organizations, including the American College of Chest Physicians American College of Cardiology, American Heart Association, and the American Stroke Association. To assure the accuracy and applicability of the information, the authors collaborated with experts in geriatric cardiology, warfarin risk assessment, prevention of deep vein thrombosis, peri-procedural anticoagulation, heparin-induced thrombocytopenia, pharmacology, and the practice of PALTC medicine. To the extent possible, this document draws on evidence from large, well-designed, randomized clinical trials; when such evidence does not exist, it presents suggested best practice based on the available literature and expert consensus. This manual focuses on issues related to atherothrombotic diseases that are addressed within the PALTC facility.

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