Residency

Thrombosis Service

Preceptors:

Sara Vazquez, PharmD, BCPS, CACP
Jolena Hagen, PharmD

Meet the Staff

Site Description

The University Thrombosis Service has 2 sites, both of which are options for the resident Thrombosis Service rotation:

University Thrombosis Center (University Hospital, preceptor Sara Vazquez): provides anticoagulation education and management via in-person patient visits for Hospital Clinic and specialty clinic patients
Redwood Anticoagulation Clinic (Redwood Health Center, preceptor Jolena Hagen): provides anticoagulation education and management via telephone for patients in University Health Care Community Clinics

Rotation Description

Residents will

Educate a minimum of three patients/caregivers initiating anticoagulation therapy.
Interview a minimum of 25 patients/caregivers regarding compliance to anticoagulation medications, dietary and/or medication changes, changes in health status, and bleeding or thrombotic complications.
Make an assessment of at least 25 patients and his/her medication therapy and communicate a plan for medication dosing and return monitoring to the patient/caregiver.
Create, communicate, and initiate an individualized periprocedural anticoagulation plan using parenteral anticoagulants for at least one patient.
Identify, manage, and report medication interactions and/or adverse effects when clinically indicated.
Respond to drug information requests from patients and providers as needed.
Present a review of recent journal article or topic update for Thrombosis Service staff.
Conduct a practice-related project for Thrombosis Service.

RLS Goals:

R2.2 Place practice priority on the delivery of patient-centered care to patients.

R2.3 As appropriate, establish collaborative professional pharmacist-patient relationships.

R2.8 Recommend or communicate regimens and monitoring plans.

R2.12 Document direct patient care activities appropriately.

R5.1 Provide effective medication and practice-related education, training, or counseling to patients, caregivers, health care professionals, and the public.

E7.1 Use approaches in all communications that display sensitivity to the cultural and personal characteristics of patients, caregivers, and health care colleagues.

Activities Evaluated:

Rotation Activity	RLS Goal	Teaching Methods
Provide high-quality, new patient anticoagulation education to a minimum of three patients and caregivers.	R2.2 R2.3 R2.12 R5.1 E7.1	Direct Instruction Modeling Coaching Facilitating
Evaluate medication therapy for at least 25 patients on antithrombotic medications. Assess compliance and identify medication-related problems. Communicate a plan for medication dosing and follow-up monitoring to the patient/caregiver and document all patient interactions in the medical record.	R2.2 R2.3 R2.8 R2.12 E7.1	Direct Instruction Modeling Coaching Facilitating
Correctly and efficiently respond to drug information requests from patients and providers daily as needed and in a timely manner.	R2.2 R2.3 R2.8 R2.12 E7.1	Modeling Coaching Facilitating
Present at least one review of a recent journal article or topic update for Thrombosis Service staff.	R5.1 E7.1	Coaching Facilitating
Conduct a practice-related project to be determined early in the rotation based on resident interests and the needs of the Service.	R5.1	Coaching Facilitating

Readings and Preparatory Work:

Acute Treatment of VTE	Wittkowsky AK. Why warfarin and heparin need to overlap when treating acute venous thromboembolism. Dis Mon. 2005; 51:112-115. Kearon C et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133 Suppl: 454S-545S. SUMMARY OF RECOMMENDATIONS ONLY
Injectable Anticoagulant Medications	Hirsh J et al. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 Suppl: 141S-159S. SUMMARY OF RECOMMENDATIONS ONLY
Warfarin	Ansell J et al. The pharmacology and management of the Vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest. 2008; 133 Suppl:160S-198S.
Reversal of Anticoagulation	Crowther MA, Warkentin TE. Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood. 2008; 111:4871-4879. Ansell J et al. The pharmacology and management of the Vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest. 2008; 133 Suppl p 175S Table 5 only.
Atrial Fibrillation	Indik JH, Alpert JS. The patient with atrial fibrillation. Am J Med 2009; 122: 415-18. Hart RG, Pearce LA. Current status of stroke risk stratification in patients with atrial fibrillation. Stroke 2009; 40;2607-2610.
Chronic Treatment of VTE	Kearon C et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133 Suppl: 454S-545S. SUMMARY OF RECOMMENDATIONS ONLY
Hypercoagulable States	Pasquali JL, Poindron V, Korganow AS, Martin T. The antiphospholipid syndrome. Best Pract Res Clin Rheumatol. 2008 Oct;22(5):831-45. Khan S, Dickerman JD. Hereditary thrombophilia. Thromb J. 2006 Sep 12;4:15.
Post-Thrombotic Syndrome	Vazquez SR, Freeman A, Van Woerkom RC, Rondina MT. Contemporary issues in the prevention and management of post-thrombotic syndrome. Ann Pharmacother 2009; 43:1824-35.
Periprocedural Anticoagulation	Douketis JD et al. The Perioperative Management of Antithrombotic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 Suppl: 299S-339S. SUMMARY OF RECOMMENDATIONS ONLY

Project Descriptions:

Journal Article Review/Topic Update Presentation
The resident will give a 30-minute presentation (15-minute presentation, 15 minutes for facilitating group discussion) on a recent thrombosis-related journal article or relevant topic update for the Thrombosis Service staff.

Practice-Related Project
The resident will complete one thrombosis-related project during rotation. The choice of project will depend on the interests of the resident and the needs of the Thrombosis Service.

Examples of Possible Projects:

Develop a protocol for patient self-testing/patient self-management of antithrombotic therapy
Develop patient/provider educational materials about post-thrombotic syndrome
Develop a provider guide/decision-making tool for appropriate use of new antithrombotic agents
Create a patient-friendly guide for prevention of VTE during long-distance travel

Typical Daily/Weekly/Monthly Activities:

Hours: 8:30am-5:00pm, Monday-Friday

Residents may design this rotation to fit their interests.

Example schedule:

Outpatient Thrombosis Service: 2 weeks
Redwood Anticoagulation Clinic: 2 weeks

Evaluations:

The resident will receive formative feedback several times per week, a summative midpoint evaluation and a summative final evaluation on the last day. Summative face-to-face evaluations will also be recorded in ResiTrak.

Pharmacy Services