Running head: PICO QUESTION 1

Antithrombotic Medications vs. Antithrombotic Devices

Stephaine Ryan
Ferris State University

Running Head: PICO QUESTION 2
Abstract
When a patient is hospitalized it is important that blood clots (thrombosis) are not formed. Many
times both medication and devices are ordered. While researching, it was found that up to 81%
of deep vein thrombosis and pulmonary embolism can be reduced by using both medications and
devices at the same time. Many institutions have policies that use both forms of prophylaxis.
Policies have been made using this type of information used in this paper. It is important that
accurate information is used before changing nursing practice and policy. Information should be
from a reputable journal, the article is peer-reviewed and the author is a medical professional.


Running Head: PICO QUESTION 3
Antithrombotic Medications vs. Antithrombotic Devices
Many patients at the hospital are prescribed antithrombotic medications, devices or both
to help prevent blood clots while being less active while hospitalized. There have been studies
performed deciding which method is the best. The purpose of this paper is to reflect on how the
knowledge gained from research can be used in personal and professional nursing practice.
PICO Question
Would using antithrombotic medications reduce a greater number of patients diagnosed
with blood clots than antithrombotic devices during hospitalization (about one week)? Studies
have been held in the medical profession on the best way to reduce the occurrence of blood clots
in hospitalized patients. These studies are being completed to determine how well each method is
reducing thrombosis.
A leader in nursing uses evidence-based research to help improve the care they give their
patients as well as influence policy at their organization. Peer-reviewed articles are articles
published in established journals that are reviewed for accuracy by other members of the medical
profession. It is important that before using the information gained from the study, that the
author is a medical professional such as a doctor or nurse. Another criterion to have when
researching is to make sure the information is reputable is that the author is employed by a health
organization or place of education.
When making the new information available to the co-workers, the nursing leader can
plan a meeting or make the article available for others to read. After the information has been
available, as well as the medical professionals having had enough time to learn about the topic,
holding a conference for those to discuss their thoughts about the information could be
necessary. As well as deciding if the information would work for their organization. Having
Running Head: PICO QUESTION 4
nurses receive the input of other co-workers and having their input on making policy will
improve the compliance of instituting the policy. If the health professionals that are using the
new policy feel they have had adequate input in making the policy, they will want to use the
newly gained knowledge to improve their nursing practice.
Research Findings
In a study by Dr. Mark Levine MD (1996), stated that when there is no prophylaxis,
between 60% and 70% [of patients] develop deep vein thrombosis and approximately 20%
develop proximal vein thrombosis (p.851). In this study, the researchers studied the use of
compression socks and medications being used separately to prevent thrombosis. When
discussing the use of compression socks, Dr. Levine MD stated, static graduated compression
stockings are effective for the prevention of venous thrombosis (p.853). When using an
antithrombotic medication such as enoxaparin, the reduction in the deep vein thrombosis rate
from 65% in the control group to 19% in the treated group (p.855). There are many studies that
are researching the use of these different types of prophylaxis but, in an article published in the
journal CHEST (2013), it is stated that the American College of Chest Physicians (ACCP) the
use of mechanical thromboprophylaxis was associated with a lower risk of incident VTE,
irrespective of concurrent administration of prophylacticenoxaparin (p.158). After
researching this topic, the articles used in this paper all stated that using both types of
antithrombotic methods at the same time are recommended. The combination of low-molecular
heparin and compression stockings was associated with statistically significant reductions in both
total venous thromboembolism (49% relative risk reduction) and proximal deep vein thrombosis
or pulmonary embolism (81% risk relative reduction) compared to the stockings alone (p.855).
Recommendations to Improve Quality and Safety
Running Head: PICO QUESTION 5
After researching the best practice, the information should be made available to other
health care workers and new policy may be written. Research noted previously in this paper,
supports using both types of methods (medication and devices) to prevent thrombosis. At
Spectrum Health, two methods to prevent thrombosis must be used. Many times enoxaparin and
SCDs are ordered to prevent the formation of clots. This improves the safety of the patients
previously mentioned article; there is a reduction of 81% of deep vein thrombosis and pulmonary
embolism. This is a high amount of patients that can remain free from being diagnosed with clots
while hospitalized. This also increases the quality of nursing the patients receive. The nurses
caring for the patient will use these methods to reduce thrombosis as well as performing
assessments to watch for the formation of clots, this improves their care.
Medical professionals can find information that improves their area of practice by
subscribing to journals relevant to their practice area. Thrombosis formation can affect all areas
of healthcare. Nurses and doctors in any area of an inpatient care use varying methods to prevent
their patients from thrombosis formation. Articles can be found in maternal/child journals,
neurological journals and general nursing journals to give a few examples. The references
provided for this paper articles were found from journals regarding surgeries, internal medicine,
and burn medicine. With the availability of the internet (i.e. at libraries, the workplace,
educational institutions), a professional can have access to many articles and journals to help
improve their practice and develop policy.
Conclusion
Before using information to change nursing practice or policy it is important that the
information is from a reputable journal and the author(s) are in the medical profession. Peer-
reviewed articles are often used because the information in the article has been reviewed by
Running Head: PICO QUESTION 6
members of the profession and found to be truthful. It is important that the information being
used to change practice and policy is correct so that patients are adversely affected instead of
helped. The research in this article has shown that using both medication and devices provide the
best reduction of the formation of blood clots. The information used to help re-enforce the policy
at Spectrum Health, where two forms of prophylaxis are used. It has been shown in the studies
that using two types of antithrombotic methods are the most successful at reducing the formation
of thrombosis.

Running Head: PICO QUESTION 7
References
Arabi, Y., Khedr, M., Dara, S., Dhar, G., Bhat, S., Tamim, H., &Afesh, L. (2013). Use of
intermittent pneumatic compression and not graduated compression stockings is
associated with lower incident VTE in critically ill patients. Retrieved from
http://journal.publications.chestnet.org/
Ferguson, R., Critchfield, A., LeClaire, A., Ajkay, N., & Vasconez, H. (2005). Current practice
of thromboprophylaxis in the burn population: a survey study of 84 US burn centers.
BURNS, 31, 964-966. doi:10.1016/j.burns.2005.06.011
Levine, M., Gent, M., Hirsh, J., Weitz, J., Turpie, A., Powers, P., Neemeh, J., Willan, A., &
Skingley, P. (1996). Ardeparin (low-molecular-weight heparin) vs graduated
compression stockings for the prevention of venous thromboembolism. Internal Medicine,
156, 851-856. doi:10.1001.archint.156.8.851
Spectrum Health. (n.d.) Policies and procedures. Retrieved from https://insite.spectrum-
health.org/clinical/Pages/Home.aspx