Publications by authors named "Rebecca Hockman"

6 Publications

  • Page 1 of 1

The Relationship between the Initial Anti-factor Xa Measurement and the Duration of Direct Oral Anticoagulant Influence in Patients Transitioning to Heparin.

Pharmacotherapy 2020 09 14;40(9):880-888. Epub 2020 Aug 14.

Department of Pharmacy, University of Colorado Health, Aurora, Colorado, USA.

Background: Anticoagulation monitoring during transition from direct oral anticoagulants (DOAC) to heparin infusions is a significant challenge. Factor Xa inhibitors influence the heparin calibrated antifactor Xa assay. The University of Virginia (UVA) Medical Center utilized a corrected antifactor Xa assay (c-AXA) during this transition period, which removes DOAC-mediated antifactor Xa activity (d-AXA) and reflects heparin-specific activity. Currently, the duration of this influence is not well described.

Study Objective: This study had two aims: to determine if the initial d-AXA is predictive of the duration of DOAC influence and to further characterize this influence among different patient populations.

Methods: This retrospective study included adult patients admitted to UVA Medical Center between September 2016 and March 2017, with c-AXA measurements, who received apixaban or rivaroxaban within 48 hours before heparin initiation. A Pearson correlation test, Kaplan-Meier Survival Analysis, and multivariate linear regression were used to assess the relationship between initial d-AXA and duration of influence.

Results: Sixty-eight patients met inclusion criteria and were maintained on either apixaban (85%) or rivaroxaban (15%) before heparin initiation. The initial d-AXA ranged from 0.11 to 3.27 IU/ml. The mean duration of influence was 69.3 ± 46.2 hours, with a median duration of 62.7 hours. No strong correlation was identified between initial d-AXA and duration of influence (R = 0.124). Presence of interacting medications significantly increased duration of influence (p=0.012). No significant difference in duration of influence existed between patients with normal renal function and those with dynamic renal function (p=0.84), or with body mass index (BMI) greater than 40 kg/m (p=0.16).

Conclusions: The initial d-AXA was not predictive of duration of influence in patients transitioning from DOACs to heparin infusion; however, the median duration of influence suggests influence may be present for longer than currently stated in the literature, especially in those taking interacting medications.
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September 2020

Clinical and Procedural Evaluation of a Pharmacy Pharmacokinetic Consult Service.

J Pharm Pract 2020 Oct 6;33(5):618-627. Epub 2019 Feb 6.

Department of Pharmacy Services, 12350University of Virginia Health System, Charlottesville, VA, USA.

Purpose: Though previous studies have shown benefit with pharmacist-managed dosing of antibiotics, many institutions still do not offer such services. Our objective was to determine and report novel outcomes associated with the implementation of a pharmacist-managed pharmacokinetic/pharmacodynamic consult service and to assess the impact of direct pharmacist involvement in therapeutic drug monitoring.

Methods: Retrospective cohort study of patients who received vancomycin or an aminoglycoside in the medical intensive care unit from January 5, 2013, to January 6, 2015, divided into 2 groups: before/after implementation of the consult service on January 6, 2014.

Results: Nine-hundred sixty-two patients were included. Groups were similar at baseline. There were fewer critical values after implementation of the consult service (40.8% vs 27.3%, < .001). The intervention group had significantly more vancomycin troughs within therapeutic range (15.4% vs 32.8%, = .019). Time from order entry to medication administration was shorter when pharmacists entered the medication order, although this difference was nonsignificant (103 minutes vs 77 minutes, = .054).

Conclusion: Implementation of a pharmacist-managed dosing and monitoring program led to significantly decreased rates of critical value drug concentrations and increased rates of therapeutic concentrations, with a 25% (NS) decreased time-to-antibiotic administration, therefore demonstrating the additive value of the pharmacist-managed over pharmacist-monitored approach.
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October 2020

Safety and effectiveness of apixaban compared to warfarin in dialysis patients.

Res Pract Thromb Haemost 2018 Apr 26;2(2):291-298. Epub 2018 Mar 26.

Division of Hematology & Oncology University of Virginia Charlottesville VA USA.

The use of apixaban for stroke prophylaxis or for the treatment of venous thromboembolism in end stage renal disease (ESRD) patients maintained on dialysis is based on one single-dose pharmacokinetic study. There is a deficiency of clinical evidence supporting safety in this population. The purpose of this study was to determine the safety and efficacy of apixaban compared with warfarin in dialysis patients. This is a retrospective cohort study conducted at the University of Virginia Medical Center. A total of 124 ESRD patients maintained on dialysis who either received apixaban (n = 74) or warfarin (n = 50) between January 1, 2014 and October 31, 2016 were included in the study. We used multivariable logistic regression to compare the likelihood of patients experiencing a bleeding event based on anticoagulant therapy. The apixaban group experienced fewer overall bleeding events than the warfarin group (18.9% vs 42.0%; =.01); this significant difference persisted in adjusted analysis (OR = 0.15; 95% CI = 0.05-0.46; =.001). Major bleeding events were less frequent in the apixaban group compared with patients on warfarin (5.4% vs 22.0%; =.01). There were no recurrent ischemic strokes in either groups. A lower, non-significant, incidence of recurrent VTE was found in patients on apixaban compared with warfarin (4.4% vs 28.6%; =.99). Compared to warfarin, our findings suggest that apixaban is a safe and effective alternative in patients with ESRD maintained on dialysis, with apixaban patients experiencing fewer bleeding events than warfarin patients.
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April 2018

Implementing guidelines for the institutional use of factor VIIa (recombinant): a multidisciplinary solution.

Am J Health Syst Pharm 2006 Sep;63(17):1641-6

South Carolina College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA.

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September 2006

Inhaled iloprost in pulmonary arterial hypertension.

Ann Pharmacother 2005 Jul-Aug;39(7-8):1265-74

Department of Pharmacy Services, University of Virginia Health System, Charlottesville, VA 22908-0674, USA.

Objective: To review the pharmacology, pharmacodynamics, and clinical trials evaluating inhaled iloprost in pulmonary arterial hypertension (PAH).

Data Sources: A MEDLINE search (1996-February 2005) was performed using the key words pulmonary hypertension, iloprost, and epoprostenol. Information regarding Food and Drug Administration approval was obtained via the Internet.

Study Selection And Data Extraction: All clinical trials using inhaled iloprost in PAH published in English were identified. Additionally, references from the identified articles were reviewed.

Data Synthesis: A stable analog of prostacyclin, inhaled iloprost is thought to promote benefit in PAH through vasodilation, antiproliferative effects, and inhibition of platelet aggregation. In a placebo-controlled trial of 203 patients, inhaled iloprost significantly improved the combined endpoint of change in New York Heart Association functional class and 10% improvement in 6-minute walk distance (p = 0.007). Small, short-term clinical trials demonstrated hemodynamic benefits for inhaled iloprost alone and in combination with other pulmonary vasodilating agents. The aerosolized delivery route and low incidence of adverse events are positive attributes for inhaled iloprost, while the frequency of administration and lack of comparative data limit its role in PAH.

Conclusions: Currently, inhaled iloprost offers potential benefit for patients with contraindications to bosentan, preference for non-parenteral products, ineligibility for parenteral therapy, or as adjunctive therapy with other pulmonary vasodilators. Larger, long-term clinical trials are needed to solidify the role for inhaled iloprost in the management of PAH.
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August 2005

Pharmacologic therapy for acute exacerbations of chronic obstructive pulmonary disease: a review.

Crit Care Nurs Clin North Am 2004 Sep;16(3):293-310, vii

Medical Intensive Care Unit, Department of Pharmacy, University of Virginia Health Sciences Center, PO Box 800674, Charlottesville, VA 22908-0674, USA.

This article reviews available data on the drug therapy armamentarium for the acute exacerbation of chronic obstructive pulmonary disease (COPD). Summaries of studies and therapeutic issues for bronchodilators, antibiotic therapy, corticosteroid use, and a few miscellaneous agents are presented. Many controversies exist in the criteria defining the acute exacerbation, in defining appropriate outcome parameters for assessment, and, consequently, in developing specific consistent recommendations for drug therapy. Five published guidelines assist the clinician in therapeutic drug management of the acute exacerbation of COPD, and each differs in its recommendations for drug therapy prescription. The article includes synopses for drug therapy recommendations from the guidelines.
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September 2004