Natalie Crown , PharmDDager WE, Gulseth MP, Nutescu EA, editors. American Society of Health-System Pharmacists, Bethesda, Maryland, 2011. 481 pages. Softcover. ISBN 978-1-58528-240-1. US$59 (US$47 for ASHP members).
Anticoagulation Therapy: A Point-of-Care Guide is a pocket-sized reference that presents an evidenced-based yet pragmatic approach to the use of anticoagulants in clinical practice.
The book consists of 19 chapters divided into 3 sections. Part 1, entitled “Anticoagulant Medication Management”, begins with an introductory chapter summarizing useful resources on anticoagulation therapy, including interpretation of the grades of recommendations used in scientific statements and clinical practice guidelines. This chapter also offers thoughtful considerations for evaluating clinical trials that involve anticoagulants. Each of the next several chapters is dedicated to one class of anticoagulants. Part 1 concludes with a chapter on reversal of anticoagulation and another called “Transitions in Care”, which provides comprehensive guidelines on switching between agents and periprocedural anticoagulation. Part 2 includes individual chapters on common medical indications for anticoagulation therapy, along with specific chapters covering special populations, such as pediatric patients and pregnant women. Part 3, entitled “Practical Monitoring and Coagulation Laboratory Insights”, covers laboratory considerations and hypercoagulability testing. The text contains several useful appendices, such as recommendations for the timing of manipulation of epidural catheters relative to the use of anticoagulants, discussions of drug-related causes of thromboembolic disease and cancer-related thromboembolism, and a comparison of available definitions of bleeding that are employed in the primary literature.
The individual chapters contain less text than typical references, consisting primarily of tables and figures interspersed with bullet points. “Clinical pearls” at the end of each section summarize the evidenced-based recommendations and, where evidence is limited, reflect expert opinion on common clinical situations that arise with anticoagulation therapy in practice. A list of references is provided at the end of each chapter, and “key articles” are highlighted. These generally include clinical practice guidelines, review articles, and landmark clinical trials. Where possible, the authors have included summaries of the primary literature in tabular format.
The editors are pharmacists who are regarded as experts in anticoagulation therapy, and each chapter is written by one or more pharmacists with experience in the management of this type of therapy.
The strengths of this text include its layout and readability, which allow the reader to access information quickly. As a point-of-care guide, it is comprehensive and addresses a wide range of anticoagulation scenarios encountered in practice. Canadian practitioners should bear in mind that because it is a US resource, information related to individual anticoagulants reflects US Food and Drug Administration labelling. This issue is of particular relevance with regard to labelling pertaining to dosing and drug interactions for the new oral anticoagulants. Canadian practitioners will also need to be aware of the effect of differences in product availability on certain areas of practice, especially anticoagulation reversal: 4-factor prothrombin complex concentrate is readily available in Canada, and an oral formulation of vitamin K is not available in this country.
Overall, this is an excellent resource that offers practitioners a practical approach to addressing clinical situations involving anticoagulation. Of particular value is the enhancement of the evidence with the authors’ expert clinical experience. This text will be relevant to pharmacists practising in both ambulatory care and the inpatient setting. It contains excellent summary tables of recommendations and monitoring parameters and effectively incorporates the use of figures such as those illustrating anatomy, the coagulation cascade, types of mechanical heart valves, and guidelines for fitting compression stockings. This text will also be a valuable resource for anyone who is teaching students, residents, and new practitioners.
Canadian Journal of Hospital Pharmacy , VOLUME 64 , NUMBER 6 , November-December 2011