RESUMO
Learning needs of patients with cancer have been examined and published widely in oncology nursing literature. However, the topic of cancer-associated thrombosis (CAT) is rarely considered a necessary inclusion. Awareness by individuals with cancer about venous thromboembolism (VTE) and its association with cancer is low (Aggarwal et al., 2015). A 2015 qualitative study by Dr. Simon Noble revealed that high-risk cancer patients receiving active chemotherapy knew more about febrile neutropenia than signs and symptoms of VTE, despite a higher absolute risk of VTE. This is concerning given that CAT is the number one cause of death for patients undergoing chemotherapy treatment. Awareness of CAT is generally low not only in patients and their families, but also in healthcare providers. Research has found that many patients diagnosed with CAT perceived a significant knowledge deficit in their treating physicians because alternative diagnoses were considered before CAT, despite classic signs and symptoms of VTE (Noble et al., 2015). VTE is a common and often severe complication in cancer patients, being the leading cause of morbidity and second leading cause of mortality (Noble et al., 2015). Despite its significance, however, the awareness of CAT is low in patients, caregivers, and healthcare providers. This article is the first in a series entitled, 'Spot the CLOT', which is aimed at promoting the awareness of CAT in oncology nurses with the goal of improving patient education on this important topic.
RESUMO
BACKGROUND: The perioperative management of patients who are receiving an anticoagulant and require a surgery/procedure is well-informed by multiple clinical studies, but an assessment of the delivery of such management is lacking. Describing the structure and function of a perioperative anticoagulation clinic provides a model for delivery of such patient care. METHODS: We examined the operational model of a perioperative anticoagulation clinic. We describe the processing and management of patients receiving anticoagulant therapy who require elective surgery or procedure, including anticoagulant interruption, resumption and consideration for bridging therapy. We also describe the patient profile assessed over an 18-month period, and the potential benefits of this clinic to patients for perioperative management and education. RESULTS: During an 18-month period, 1061 patients were assessed. Atrial fibrillation and venous thromboembolism were the most common indications for anticoagulant therapy, comprising 55.0% and 26.5% of patients, respectively; 44.1% of patients were taking warfarin, 37.1% were taking direct oral anticoagulants, and 12.3% were receiving low-molecular-weight heparin. The key components of this clinic model emphasizes a patient-centered approach to perioperative anticoagulant management based on evidence-based management protocols, alongside patient and family education that is delivered by a multi-disciplinary team approach. CONCLUSIONS: Our perioperative anticoagulation clinic model provides one approach to the delivery of perioperative anticoagulant management, with the potential to optimize patient safety, improve patient education, and minimize health care costs.