PGY1 International Graduates Pharmacy Residency

Assessment of patients readmitted with venous thromboembolism within 30 days from index admission for high risk factor

Abdullah O. Alshehry, PharmD, MBA; Allison Wilson, PharmD, BCPS; Michelle Murillo, PharmD; Wilda Chung On, PharmD, MBA; Kim Ngo, PharmD; Erica Martin, PharmD; BCPS, Nghi (Andy) Bui, PharmD, BCPS

PURPOSE

To compare patients readmitted with VTE and without VTE within 30 days from index admission to identify risk factors that predisposed them to readmissions with VTE, modelling off the CRAM criteria.

METHODS

In this retrospective chart review, patients readmitted within 30 days to the Houston Methodist Hospital System, Houston, Texas from 2016 to 2020 with VTE as a principal diagnosis were compared to patients readmitted within 30 days without VTE. The objective of this study was to describe the differences in baseline characteristics, comorbidities, and contributing risk factors for VTE, based on risk factors assessed in the Caprini Risk Assessment Model (CRAM).

RESULTS

Data for 100 patients in each group were evaluated. Some VTE risk factors were numerically higher in the VTE group compared to the control group, such as obesity (72 vs 66), sepsis (26 vs 3), pneumonia (25 vs. 6), malignancy (24 vs. 10), stroke (7 vs. 0) or a history of hip, pelvis, or leg fracture (17 vs. 3). The median Caprini score was 8 points (IQR = 5 -11) in the VTE groups and 6 points (IQR = 5 -7) in the control group. A total of 34 patients in the VTE group received appropriate VTE prophylaxis compared to 57 patients in the control group.

CONCLUSION

Malignancy and diseases with inflammatory burden were associated with increased risk of readmission with VTE within 30 days. Caprini score may provide a better objective predictor of VTE risk within 30 days from hospitalization.

PGY1 PHARMACY RESIDENCY - INTERNATIONAL GRADUATES

Abdullah Alshehry, PharmD

Abdullah earned his BS in Pharmacy from King Saud University in Riyadh, Saudi Arabia in 2010 and PharmD and MBA from Long Island University, New York, NY in 2010. Following completion of his PGY1, Abdullah will practice as clinical pharmacist at King Fahad Medical City,Riyadh, KSA. Primary project preceptor: Nghi (Andy) Bui, PharmD, BCPS

Presented at 2021 Virtual Midwest Pharmacy Residents Conference

Evaluation of outcomes with apixaban use for venous thromboembolism in hospitalized patients with end-stage renal disease receiving renal replacement therapy

Jingshi Chen, PharmD; Steffany Nguyen, PharmD, BCPS; Melanie Ruegger, PharmD, BCPS; Leena Samuel, MD; Eric Salazar, MD, PhD; Ian Dunne, PharmD, BCPS

PURPOSE Direct oral anticoagulants (DOACs) have revolutionized anticoagulation therapy. While apixaban and rivaroxaban received expanded labeling for use in atrial fibrillation for end-stage renal disease (ESRD) patients based on pharmacokinetic trials, little data exists regarding the use of DOACs in ESRD patients requiring renal replacement therapy (RRT) for venous thromboembolism (VTE).

METHODS

This retrospective, descriptive cohort study was conducted from May 2016 to September 2020 at Houston Methodist Hospital System. Adult patients with a diagnosis of ESRD on RRT and with a VTE diagnosis receiving apixaban therapy prior to or during admission were included. The primary objective was to identify major bleeding events within 72 hours of last apixaban dose administration. Secondary objectives included new VTE while on apixaban, appropriateness of anticoagulation regimen with regards to FDA labeled dosing and frequency, anticoagulation regimen adjustments, and factor Xa inhibitor-specific anti-Xa levels if available.

RESULTS

A total of 68 patients met criteria for inclusion in the final analysis. Major bleeding events occurred in 9 (13.2%) of patients receiving apixaban within the last 72 hours. Among these patients, 2 were taking apixaban 10 mg twice daily, 2 were taking apixaban 5 mg twice daily, and 5 were on apixaban 2.5 mg twice daily dosing.

CONCLUSION

The use of apixaban for VTE in patients with ESRD on RRT may lead to an increased risk of bleeding. Therefore, apixaban use should occur following shared decision making especially if there is no contraindication to warfarin.

PGY1 PHARMACY RESIDENCY - INTERNATIONAL GRADUATES

Jingshi “Iris” Chen, PharmD

Iris earned her BS in chemistry from Rhodes College in 2016 and PharmD from the University of Iowa in 2020. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY1, Iris will seek for a clinical pharmacist position in the future. Primary project preceptor: Ian Dunne, PharmD, BCPS

Presented at 2021 Virtual Midwest Pharmacy Residents Conference

Impact of statins on the incidence of gastrointestinal bleeding events among patients with continuous flow left ventricular assist devices

Hala Halawi, PharmD; Jesse E. Harris, PharmD, BCCCP; David Putney, PharmD, BCPS, MPH; Duc T. Nguyen, MD, PhD; Edward A. Graviss, PhD, MPH, FIDSA; Mahwash Kassi, MD

PURPOSE

Patients with continuous flow left ventricular assist devices (CF-LVADs) are at increased risk of gastrointestinal bleeding (GIB) events due to non-pulsatile flows of the device. LVAD patients also commonly receive statins for the primary or secondary prevention of cardiovascular disease. However, the impact of such therapy on the incidence of GIB is controversial. Importantly, literature regarding the impact of statins on GIB in LVAD patients is lacking.

METHODS

This was a single-center, retrospective review of adult patients that underwent CF-LVAD implantation between May 2016 and January 2020. Patients were categorized based on statin use throughout the study period. The primary outcome was the composite of arteriovenous malformation (AVM) confirmed GIB and other major GIB events for up to 1-year post-LVAD implantation. Secondary outcomes included each of the components of the primary outcome, non-clinically relevant GIB, time to GIB, and frequency of GIB. Multivariable Cox regression was utilized to assess association between confounding variables and GIB.

RESULTS Of the 123 patients who met inclusion criteria, 66 (54%) received statin therapy during the study period. No difference was observed in the primary outcome of major GIB between the statin and non-statin groups (21.2% vs. 12.3%, p=0.19). Similarly, AVM confirmed GIB (12.1% vs. 5.3%, p=0.22), other major GIB (9.1% vs. 7.0%, p=0.75), and non-clinically relevant GIB (3.0% vs. 1.8%, p=0.65) were similar between the two groups. Using a competing risk modeling, we observed no difference in the development of a major GIB (32.4% vs. 18.7%, p=0.14) or in the frequency of major GIB [1.5 (interquartile range, 1-2) vs. 1 (1-1), p=0.12] within 12 months of device implantation. Multivariable Cox regression revealed that older age and higher baseline creatinine were associated with an increased risk of GIB within 1-year of LVAD implantation (p<0.05 for both).

CONCLUSION

Among patients with CF-LVADs, there was a non-significant increase in the incidence of major GIB events with the use of statin therapy. Further long-term studies are needed to determine if statin use has a significant impact on the incidence of GIB events among this patient population.

PGY1 PHARMACY RESIDENCY - INTERNATIONAL GRADUATES

Hala Halawi, PharmD

Hala earned her PharmD degree from the Lebanese American University in 2020. She is completing her PGY1 pharmacy residency at Houston Methodist Hospital. Following completion of her PGY1, Hala will be staying at Houston Methodist Hospital to complete a PGY2 in critical care.

Primary project preceptor: Jesse E. Harris, PharmD, BCCCP

Presented at 2020 Virtual Midwest Pharmacy Residents Conference; 2021 Society of Critical Care Medicine Texas Chapter 10th Annual Symposium