Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

1)DVT prophylaxis in special populations. 2)Comparative effectiveness between heparin and LWMH (low molecular weight heparins).

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Currently special populations (trauma, burns, hip/knee surgery) at very high risk of DVT prophylaxis are receiving enoxaparin 30mg Q12 hrs but not compared to heparin 10,000 units Q12 hrs.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Age range 18-100 y/o M&F Diagnosis: Burns, trauma, hip or knee surgery, obese, very high risk for DVT.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

ESRD patients have precautions and higher bleeding risks with LWMH. Low income groups compliance due to high cost of LWMH.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Identify proper dosing for very high risk DVT prophylaxis patients in special populations. Alternative dosing of heparin and comparative effectiveness between heparin and LWMH.

Describe any health-related risks, side effects, or harms that you are concerned about.

DVT/PE rates and bleeding side effects

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension
• Obesity
• Pulmonary disease/asthma

AHRQ Priority Populations

• Low income groups
• Minority groups
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

None

Importance

Describe why this topic is important.

DVT prophylaxis is a major quality and preventative measure. A major patient safety goal of Joint Commission on the Accreditation of Healthcare Organizations.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Clinical data insufficient on heparin and alternative treatment has substantially more issues with bleeding in patient with renal disease and more costly.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

No current data comparing the effective treatments or alternative dosing of heparin

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Provide better treatment in special population that are hgih risk for DVT.

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Data for special populations with LWMH is limited and no data with higher or alternative dosing with heparin which would benefit renal disease patients and low-income groups.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Provide better treatment in special population that are hgih risk for DVT.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program