Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 63: Chemo Prophylaxis with Andrew Jarrell
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Dec 1, 2017 In this discussion, Andrew Jarrell, a SICU pharmacist at Johns Hopkins, shares his expertise on VTE and stress ulcer prophylaxis. He dives into the surprising incidence of VTE in hospitalized patients and the effectiveness of prophylaxis in reducing risks. The conversation explores guidelines for balancing risks, mechanical prophylaxis methods, and the controversial use of IVC filters. Andrew also explains the significance of assessing individual risk factors and the necessity of reconsidering routine stress ulcer prophylaxis, highlighting recent evidence and evolving practices.
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VTE Is Common And Preventable
- Without prophylaxis, 10–30% of hospitalized patients develop VTE depending on screening and population.
- Pharmacologic prophylaxis cuts VTE incidence by 45–70% and mechanical measures plus ambulation also reduce risk.
Use Risk + Bleeding Balance To Guide Prophylaxis
- Use guideline frameworks (CHEST and specialty guidelines) to decide prophylaxis based on admission diagnosis and VTE risk.
- Always weigh bleeding risk, including neuraxial analgesia timing, when choosing pharmacologic prophylaxis.
Prefer SCDs Over Stockings
- Prefer sequential compression devices (SCDs/IPC) over TED stockings for mechanical VTE prevention.
- SCDs may work via fibrinolytic effects, not only by changing leg blood flow, so temporary single-leg use still offers benefit.