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HealthTrust Presents…“The Great Load Debate: Transitioning from Parenteral Anticoagulation to Direct Oral Anticoagulants in the Treatment Phase of Deep Vein Thrombosis and Pulmonary Embolism”

The risk of recurrent venous thromboembolism is greatest during the first week following an acute thrombotic event and remains elevated throughout the first 30 days.  A meta-analysis of 15 studies confirmed that recurrence risk peaks in week one, declines over weeks two to four, and stabilizes after week five.

Major direct oral anticoagulant (DOAC) trials addressed the early high-risk phase using intensified initial therapy. AMPLIFY and EINSTEIN used higher lead-in dosing, whereas HOKUSAI-VTE and RE-COVER required 5-10 days of parenteral anticoagulation before transitioning to oral therapy. Notably, most trial patients received less than or equal to 48 hours of parenteral anticoagulation, which is shorter than typical real-world practice. This discrepancy creates clinical uncertainty regarding whether parenteral days of therapy should count toward the DOAC lead-in duration or whether the full oral lead-in regimen should still be given. Consequently, practices vary: some clinicians adjust the lead-in period by subtracting parenteral days, while others administer the full duration regardless of prior parenteral therapy. At the end of this presentation, attendees should be able to apply evidence-based principles to guide safe and effective transitions from parenteral to oral treatment-dose anticoagulation in patients with acute venous thromboembolism, including appropriate direct oral anticoagulant selection, lead-in dosing, and duration strategies.

Learning Objectives | At the end of this session, participants should be able to:

1. Recall the pharmacologic rationale for lead-in dosing with direct oral anticoagulants (DOACs) in the treatment of acute venous thromboembolism (VTE).
2.  Identify parental and oral pharmacological therapies for venous thromboembolism (VTE) treatment.
3. Recognize evidence-based principles and patient-specific factors to recommend appropriate treatment strategies when transitioning from parenteral anticoagulation to direct oral anticoagulants (DOACs) in the management of deep vein thrombosis and pulmonary embolism.

Presenter:

Savannah Odom, PharmD  |  PGY1 Pharmacy Resident  |  McLeod Health  |  Florence, SC

Target Audience:  Pharmacists & Nurses

CE Credit: Approved for Nurses; pending for Pharmacists

This program is pending approval for CPEs by the Accreditation Council for Pharmacy Education (ACPE). Attendees of this program may earn 1.0 CPE Contact Hours. Belmont University College of Pharmacy & Health Sciences is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. The Universal Activity Number for this activity is pending. Pfiedler Education is a division of AORN, provider approved by the California Board of Registered Nursing, Provider Number CEP13019, for 1 contact hour. 1.0 contact hours approved for Nurses.

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Note about CE credit: If you plan to obtain credit for a live session, stay until the end of the presentation to receive the verification code you will need to obtain the continuing education credit. CE credit is individual. No group credit is available. Each person must register for a webinar and attend the webinar in its entirety in order to receive an email after the event with instructions on how to apply for continuing education credit. Attendees should not share the code or forward the email to others who did not actually attend the program. If they are not able to be verified on our webinar provider reports and registration list they will not receive credit. If you are joining only by phone, you will not be eligible for credit. You must also log in and join the visual portion of the webinar to be part of our CE provider-required reporting.