Pharmacists' guide to the management of organ donors after brain death.

PURPOSE: This article reviews organ donor pathophysiology as it relates to medication use with the goal of maximizing the successful procurement and transplantation of donor organs. SUMMARY: The number of patients requiring organ transplantation continues to grow, yet organ donation rates remain flat, making it critical to appropriately manage each organ donor in order to ensure viability of all transplantable organs. The care given to one organ donor is tantamount to the care of several transplant recipients. Aggressive donor management ensures that the largest number of organs can be successfully procured and improves the organs' overall quality. Hospital pharmacists are responsible for processing orders and preparing the medications outlined in donor management algorithms developed by their respective medical systems. It is important that pharmacists understand the details of the medications used in these protocols in order to critically evaluate each medication order and appropriately manage the donor. Typical medications used in organ donors after brain death include medications for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. CONCLUSION: It is essential to provide optimal pharmacotherapy for each organ donor to ensure organ recovery and donation. Typical medications used in organ donors include agents for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions.

Analysis of anticoagulant prescribing in non-valvular atrial fibrillation and development of a clinical tool for guiding anticoagulant selection.

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the United States. Traditionally, warfarin has been used to prevent the occurrence of stroke in intermediate-to-high risk patients. Target-specific oral anticoagulants (TSOACs) have become a favorable alternative; however, recommendations for differentiating between the available TSOACs were lacking within the 2012 CHEST guidelines. The objective of this retrospective, observational study was to identify current anticoagulation prescribing habits in patients admitted with new-onset AF, and evaluate the appropriateness of discharge therapy based on national guidelines. Additionally, a practice guideline was created for use at our institution to stratify appropriate use of TSOACs. Patients were included if they were at least 18 years old and were admitted with a primary diagnosis of new-onset, non-valvular AF between July 1, 2012 and June 30, 2013. CHADS2, CHA2DS2VASc, and HAS-BLED scores were calculated based on patient data. Between July 2012 and June 2013, 143 patients were included in the study. The average CHADS2 score was 1.7, the average CHA2DS2VASc score was 3.0, and the average HAS-BLED score was 2.4. The use of no antithrombotics decreased as the CHA2DS2VASc score increased, aspirin use stayed consistent across risk groups, warfarin use increased as the CHA2DS2VASc score increased, and TSOAC use decreased with increasing CHA2DS2VASc score. A total of 34 % of study patients were prescribed inappropriate treatment upon discharge, based on national guidelines. This study demonstrated that patients admitted to our hospital were prescribed appropriate therapy the majority of the time; however, 34 % were prescribed inadequate antithrombotic therapy compared to current practice guidelines given their CHA2DS2VASc score. The development of an institution-specific guideline stratifying appropriate use of anticoagulation in this population may increase adherence to national guideline recommendations.