Episode 63: Chemo Prophylaxis with Andrew Jarrell

This podcast addresses the prophylaxis of venous thromboembolism (VTE) and stress ulcers in hospitalized patients. Andrew Jarrell, a SICU pharmacist at Johns Hopkins, explains that VTE can affect 10-30% of patients without prophylaxis, with the risk varying based on surgery type and patient population. Guidelines emphasize balancing VTE risk against bleeding risk, considering factors like ambulation, compression stockings, and IVC filters. The discussion covers pharmacologic options such as unfractionated heparin, low molecular weight heparin, fondaparinux, and aspirin, including dosing considerations for different patient weights and renal function. The podcast further explores stress ulcers, a type of hemorrhagic gastritis, and the use of proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) for prophylaxis, while also weighing potential downsides like pneumonia and C. difficile infection.

Outlines

Part 1: VTE Epidemiology, Guidelines, and Mechanical Strategies

Part 2: Risk Assessment and Patient Populations

Part 3: Pharmacologic Options and Dosing for VTE

Part 4: Stress Ulcer Prophylaxis: Risks and Medications

Part 5: Interactions and Clinical Necessity

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Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Part 1: VTE Epidemiology, Guidelines, and Mechanical Strategies

Introduction to VTE and Stress Ulcer Prophylaxis in the SICU

Epidemiology and Significance of Venous Thromboembolism (VTE)

Guidelines and Mechanical Strategies for VTE Prophylaxis

Controversies and Evidence Regarding IVC Filters for VTE Prevention

Part 2: Risk Assessment and Patient Populations

Secondary Prophylaxis with IVC Filters and VTE Risk Factors

VTE Risk Factors in Cardiac, Thoracic, Orthopedic, and Trauma Patients

Part 3: Pharmacologic Options and Dosing for VTE

Pharmacologic Options for VTE Prophylaxis: Heparin Dosing

Low Molecular Weight Heparin, Fondaparinux, and Reversal Agents

Aspirin for VTE Prophylaxis, Weight Considerations, and Prophylaxis Timing

Part 4: Stress Ulcer Prophylaxis: Risks and Medications

Introduction to Stress Ulcer Prophylaxis: Definition and Necessity

Risk Factors and Drug Options for Stress Ulcer Prophylaxis

Adverse Effects of Stress Ulcer Prophylaxis: Pneumonia, C. diff, and Kidney Injury

Part 5: Interactions and Clinical Necessity

Drug-Drug Interactions with Stress Ulcer Prophylaxis

Questioning the Necessity of Stress Ulcer Prophylaxis and Listener Engagement

Episode 63: Chemo Prophylaxis with Andrew Jarrell

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Part 1: VTE Epidemiology, Guidelines, and Mechanical Strategies

00:00Introduction to VTE and Stress Ulcer Prophylaxis in the SICU

Introduction to VTE and Stress Ulcer Prophylaxis in the SICU

03:06Epidemiology and Significance of Venous Thromboembolism (VTE)

Epidemiology and Significance of Venous Thromboembolism (VTE)

06:52Guidelines and Mechanical Strategies for VTE Prophylaxis

Guidelines and Mechanical Strategies for VTE Prophylaxis

12:21Controversies and Evidence Regarding IVC Filters for VTE Prevention

Controversies and Evidence Regarding IVC Filters for VTE Prevention

Part 2: Risk Assessment and Patient Populations

15:03Secondary Prophylaxis with IVC Filters and VTE Risk Factors

Secondary Prophylaxis with IVC Filters and VTE Risk Factors

18:34VTE Risk Factors in Cardiac, Thoracic, Orthopedic, and Trauma Patients

VTE Risk Factors in Cardiac, Thoracic, Orthopedic, and Trauma Patients

Part 3: Pharmacologic Options and Dosing for VTE

20:26Pharmacologic Options for VTE Prophylaxis: Heparin Dosing

Pharmacologic Options for VTE Prophylaxis: Heparin Dosing

23:38Low Molecular Weight Heparin, Fondaparinux, and Reversal Agents

Low Molecular Weight Heparin, Fondaparinux, and Reversal Agents

27:33Aspirin for VTE Prophylaxis, Weight Considerations, and Prophylaxis Timing

Aspirin for VTE Prophylaxis, Weight Considerations, and Prophylaxis Timing

Part 4: Stress Ulcer Prophylaxis: Risks and Medications

32:34Introduction to Stress Ulcer Prophylaxis: Definition and Necessity

Introduction to Stress Ulcer Prophylaxis: Definition and Necessity

35:14Risk Factors and Drug Options for Stress Ulcer Prophylaxis

Risk Factors and Drug Options for Stress Ulcer Prophylaxis

38:27Adverse Effects of Stress Ulcer Prophylaxis: Pneumonia, C. diff, and Kidney Injury

Adverse Effects of Stress Ulcer Prophylaxis: Pneumonia, C. diff, and Kidney Injury

Part 5: Interactions and Clinical Necessity

41:23Drug-Drug Interactions with Stress Ulcer Prophylaxis

Drug-Drug Interactions with Stress Ulcer Prophylaxis

44:22Questioning the Necessity of Stress Ulcer Prophylaxis and Listener Engagement

Questioning the Necessity of Stress Ulcer Prophylaxis and Listener Engagement