A Pharmacist-Led VTE Management Program in Orthopedic Surgery Associated with Reduced Venous Thromboembolism and Increased Pharmacological Prophylaxis: A Retrospective Study

Yalan Wang,1,2 Songqing Liu,1 Xuejiao Tang,3 Guili Huang,1 Xin Xi,1 Jun Zhu,1 Qian Du,1,* Jie Dong1,* 1Pharmacy Department, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2College of Pharmacy, Chongqing Medical University, Chongqing, People’s Republic of China; 3Medical Administration Department, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jie Dong, Pharmacy Department, The Third Affiliated Hospital of Chongqing Medical University, Shuanghu Branch Road 1, Chongqing, People’s Republic of China, Email [email protected] Qian Du, Pharmacy Department, The Third Affiliated Hospital of Chongqing Medical University, Shuanghu Branch Road 1, Chongqing, People’s Republic of China, Email [email protected]: This study aimed to develop and assess the impact of a pharmacist-led, technology-supported venous thromboembolism (VTE) management program on improving VTE prophylaxis and incidence in patients undergoing orthopaedic surgery.Patients and Methods: This was a retrospective, observational study with a pre-post design conducted in the trauma and joint ward of the Orthopaedic Department of a tertiary hospital in Chongqing, China. Surgical patients were included from the period before (December 2022 to May 2023) and after (June to November 2023) the implementation of pharmacist-led VTE management program (PL-VTEMP), in which pharmacists conducted standardized VTE risk verification and proactive medication monitoring. Primary endpoints included VTE incidence and prophylactic pharmacotherapy rate. Multivariable logistic regression was used to adjust for potential confounders, along with an E-value analysis to assess robustness to unmeasured confounding.Results: In total, 651 participants were included (322 in the pre-program group and 329 in the post-program group). Following the implementation of pharmacist-led VTE management program, the incidence of VTE decreased significantly (7.8% vs 2.7%, p = 0.004) and the proportion of patients receiving pharmacological prophylaxis increased significantly among high-risk patients in the post-program group (51.6% vs 33.9%, p < 0.01). The pharmacist-led VTE management program was identified as a protective factor for VTE prevention in multivariate regression model (OR 0.223, 95% confidence interval [CI] 0.093– 0.535). Despite the average duration of drug prophylaxis not significantly increased to match guideline recommendations (7.18 days vs 6.80 days, p > 0.05), the proportion of patients receiving oral sequential anticoagulants had risen (29.4% vs 2.3%, p < 0.001). No significant differences were observed in the incidence of bleeding.Conclusion: This study demonstrated the benefits of pharmacist-led VTE management program as thromboprophylaxis in patients undergoing orthopaedic surgery. Clinical pharmacists have the potential to be core members of the VTE management team.Keywords: pharmacist services, VTE, trauma orthopaedic, multidisciplinary management