The Lack of Clinical Pharmacists Causes Injuries to NBA Players

It was reported this week that the Cleveland Cavaliers’ all-star caliber center Anderson Varejao suffered from a blood clot in his lower right lung, rendering him out for the remaining NBA season this year.

Varejao, who led the NBA in rebounding before he went down last month with a bruised knee, underwent surgery on a torn leg muscle on January 10, and has been at the Cleveland Clinic since last Thursday.

This is type of injury is not atypical.  A blood clot in the lungs (termed, a pulmonary embolism [PE]) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism).  PE most commonly results from deep vein thrombosis (a blood clot in the deep veins of the legs or pelvis) that breaks off and migrates to the lung, a process termed venous thromboembolism (VTE).

The development of thrombosis is classically due to alterations in blood flow, factors in the vessel wall, and/or factors affecting the properties of the blood.  One major risk factor that affects blood flow is immobilization (after surgery, injury, or pregnancy).  PE’s however can be prevented when these circumstances occur, and intervention by clinical pharmacists increase the likelihood that patients recovery from surgery without ever having a life-threatening blood clot.

A prospective study (with retrospective data collection) was conducted utilizing data from 1879 patients (in 2006) as a control cohort; the intervention cohort data were from 1646 patients during 2007, after Pharmacist-ran intervention program was implemented (Mahan et al, 2012).  In the program, Pharmacists identified risk factors in hospitalized patients and employed VTE prophylaxis when such factors were present.

The study concluded that a pharmacy-led multifaceted intervention can significantly increase the rates of appropriate prophylaxis (eg, blood thinning agents, leg compression) and significantly reduce the incidence of preventable VTE in hospitalized patients.

Had the hospital employed more clinical pharmacists, Varejao may have been properly prophylaxed and he would have never experienced a VTE.  Varejao isn’t the only sufferer from this condition.

Tennis star Serena Williams was diagnosed with a pulmonary embolism in February 2011 and later needed treatment for a hematoma.  The 13-time Grand Slam champion claimed she was on her ‘death bed’ due to the injury and was unable to compete for nearly a year.

It is obvious that Pharmacists’ presence in the acute and impatient clinical care setting is hugely underutilized, and the expertise of clinical pharmacists has gone greatly underappreciated.  Patients can benefit greatly from pharmacist intervention, and professional athletes may prevent severe injury (and even death) if these health care professionals are employed and present.

-Deshawn (@ShonJay714)

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    • Sariem
      September 10, 2013

      I wonder what Varejao’s post-op plan included. I can’t imagine a patient receiving surgery and not being prescribed anticoagulants or antithrombolytic therapy thereafter by his surgeon or physician or whoever was looking after him. That just seems odd. I obviously don’t know all the details of his case but perhaps the ball was dropped in his instance. It’s great to have a clinical pharmacist, don’t get me wrong, but I think his provider should have known better and should have taken the appropriate actions to prevent a VTE/DVT post-surgery. I do agree that collaboration with a clinical pharmacist would have been helpful.

      With that said, I do appreciate clinical pharmacists–whether in an acute or primary care setting.


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