Dr. Dunn’s research focuses on two areas: (1) anticoagulation & thrombosis and (2) health care delivery models. In many ways these areas intersect, as the safe and efficient delivery of anticoagulation to prevent and treat thromboembolism requires that safe systems be designed and implemented. His work in anticoagulation includes development of a novel outpatient venous thromboembolism (VTE) treatment program and investigation of the utility of peri-operative “bridging” for patients on warfarin. More recently, the majority of his research efforts have focused on developing safer and more efficient models of care within hospitals, including studying the potential benefits of a bedside interdisciplinary rounding model. He has again merged the concepts of anticoagulation and health care delivery systems in his work as senior investigator on Dr. Eric Goodman’s grant-funded project investigating a bundled intervention to improve the transition of care for patients with acute VTE.
Dunn Hospital Medicine Research Program
This trial investigates the impact of transforming standard daily interdisciplinary rounds from a conference room to a bedside model. The interdisciplinary team includes the Nurse Manager and Unit Medical Director, the hospitalist, staff nurse, social worker, and case manager. An enhanced structure, scripting, and a patient safety checklist are utilized. Patient engagement and input is an integral component of the model. Outcomes include LOS, hospital-acquired complications, and patient satisfaction.
Dr. Dunn has performed several studies examining the peri-operative management of warfarin. The BRIDGE trial was a randomized controlled trial investigating the risks and benefits of “bridging” anticoagulation versus no “bridging” in patients with atrial fibrillation on chronic warfarin undergoing surgical procedures. The study found that bridging did not decrease the risk of stroke or peripheral arterial embolism, and increased the risk of major and minor bleeding.
Original Peer-reviewed Articles
Dunn AS, Peterson KL, Schechter CB, Rabito P, Gotlin AD, Smith LG. The utility of an in-hospital observation period after discontinuing intravenous antibiotics. Am J Med. 1999;1:6-10.
Dunn AS, Coller B. Outpatient deep vein thrombosis treatment: translating clinical trials into practice. Am J Med. 1999;106:660-9.
Dunn AS, Shridharani K, Lou W, Bernstein R, Horowitz C. Physician-patient discussions of controversial cancer screening tests. Am J Prev Med. 2001;20:130-4.
Dunn AS, Schechter C, Gotlin A, Vomvolakis D, Jacobs E, Sacks HS, Coller B. Outpatient treatment of deep vein thrombosis in a diverse inner-city population. Am J Med. 2001;110:458-62.
Dunn AS, McGinn T. An evidence-based approach to the diagnosis of deep vein thrombosis: Beyond the ultrasound report. J Am Geri Soc. 2002;50:577-80.
Korenstein D, Dunn AS, McGinn T. Mixing it up: integrating evidence-based medicine and patient care. Academic Medicine. 2002;77:741-2.
Dunn AS, AGG Turpie. Perioperative management of patients on oral anticoagulants: a systematic review. Arch Intern Med. 2003;163:901-8.
Dunn AS, Bioh D, Beran M, Capasso M, Siu AL. The impact of intravenous heparin administration on duration of hospitalization. Mayo Clinic Proc. 2004;79:159-63.
Dunn AS. Perioperative management of patients on oral anticoagulation. Cardiovasc Rev and Rep. 2004;25:208-11.
Kaboli PJ, Brenner A, Dunn AS. Prevention of venous thromboembolism in medical and surgical patients. Clev Clin J Med. 2005;72(Supplement 1):S7-S13.
Dunn AS, Ho W, Wisnivesky J, Moore C, McGinn T, Sacks HS. Perioperative management of patients on oral anticoagulants: a decision-analysis. Medical Decision-Making. 2005;25:387-97.
Dunn AS, Kaboli P, Halfdanarson T, Chan H, Hubert R, White RH. Do patients followed in anticoagulation clinics for antiphospholipid antibody syndrome meet criteria for the disorder? Thromb Haem. 2005;94:548-54.
Dunn AS. Perioperative management of oral anticoagulation: when and how to bridge. J Thromb Thrombolysis. 2006; 21:85-9.
Lin, JJ, Moore C, Dunn AS. Follow-up of outpatient test results: a survey of housestaff practices and perceptions. Am J Med Qual. 2006;21:178-84.
Dunn AS, Brenner A. Halm E. The magnitude of an iatrogenic disorder: A systematic review of the incidence of venous thromboembolism for general medical inpatients Thromb Haem. 2006;95:758-62.
Spyropoulos AC, Turpie AG, Dunn AS, Spandorfer J, Douketis J, Jacobson A, et al. Clinical outcomes with unfractionated heparin or low-molecular-weight heparin as bridging therapy in patients on long-term oral anticoagulants: the REGIMEN registry. J Throb Haem. 2006;4:1246-52.
Dunn AS, Spyropoulos AC, Turpie AG. Bridging therapy in patients on long-term oral anticoagulant therapy who require surgery: the Prospective Perioperative Enoxaparin Cohort Trial (PROSPECT). J Thromb Haem. 2007;5:2211-8.
Douketis JD, Berger PB, Dunn AS, et al. The perioperative management of antithrombotic therapy. American College of Chest Physicians evidence-based practice guidelines (8th edition). Chest. 2008;133:299-339S.
Spyropoulos AC, Turpie AG, Dunn AS, et al. Perioperative bridging therapy with unfractionated heparin or low-molecular-weight heparin in patients with mechanical prosthetic heart valves on long-term oral anticoagulants (the REGIMEN Registry). Am J Cardiol. 2008;102:883-9.
Dunn AS. Hospital medicine in high-def: The importance of defining the local mission of hospitalist groups. Mount Sinai J Med. 2008;75:415-417.
Dunn AS, Markoff B. Physician-physician communication: What’s the hang-up? J Gen Int Med. 2009;24:437-9.
Briones A, Markoff B, Kathuria N, Jagoda A, Baumlin K, Hill S, Mumm, A, Jervis R, Dunn, AS. A model of a hospitalist role in the care of admitted patients in the emergency department. J Hosp Med. 2010;5:360-4.
O’Leary KJ, Afsar-manesh N, Budnitz T, Dunn AS, Myers JS. Hospital quality and patient safety competencies: development, description, and recommendations for use. J Hosp Med. 2011;6:530-6.
Foer D, Ornstein K, Soriano TA, Kathuria N, Dunn AS. Nonmedical factors associated with prolonged hospital length of stay in an urban homebound population. J Hosp Med. 2012;7:73-8.
Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in Nonsurgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2012;141(suppl 2):195S-226S.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R. Perioperative management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2012;141(suppl 2):326S-350S.
Ahmed J, Ornstein K, Dunn A, Gliatto P. Incidence of venous thromboembolism in a homebound population. J Comm Health. 2013;30:994-8.
Tamler R, Dunn AS, Leroith D. Effect of online diabetes training for hospitalists on inpatient glycemia. Diabetic Med. 2013;30:994-8.
Berger, A, Dunn AS, Kelley AS. A standardized bleeding risk score aligns anticoagulation choices with current evidence. Crit Pathways Cardiol. 2014;12:109-13.
Tadros RO, Fairies PL, Malik R, et al. The effect of a hospitalist comanagement service on vascular surgery inpatients. J Vasc Surg. 2015;61:1550-5
Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N Engl J Med. 2015; 373:823-33.
Dunn AS, Shetreat-Klein A, Berman J, et al. Improving transitions of care for patients on warfarin: The safe transitions anticoagulation report. J Hosp Med. 2015;10:615-8.
Other Publications
Dunn AS. [Letter] Autosomal/Recessive: Familial Hypocalciuric Hypercalcemia. Ann Intern Med. 1997;126:835.
Dunn AS. Oral Heparin. IDrugs. 2000;3:817-24.
Perler BA, Blanco JJ, Dalsey WC, Dunn AS, Llewellyn A, Meltzer BA, et al. Treatment of deep vein thrombosis in the outpatient setting (Part 1). Home Health Care Consultant. July 2002:11-18.
Perler BA, Blanco JJ, Dalsey WC, Dunn AS, Llewellyn A, Meltzer BA, et al. Treatment of deep vein thrombosis in the outpatient setting (Part 2). Home Health Care Consultant. August 2002:13-20.
Dunn AS, AGG Turpie. In Reply. Perioperative anticoagulation. Arch Intern Med. 2003;163:2533.
Brenner A, Halm E, Dunn AS. The incidence of venous thromboembolism and efficacy of prophylaxis for medical inpatients: a systematic review. J Gen Int Med. 2004;19(Suppl 1):222.
Spyropoulos AC, Dunn AS, Turpie AG, Kaatz S, Spandorfer J, Douketis J, Jacobson A, et al. Perioperative bridging therapy with unfractionated heparin or low-molecular-weight heparin in patients with mechanical heart valves on long-term oral anticoagulants: Results from the REGIMEN registry. J Am Coll Cardiol. 2005;45:352a.
Dunn AS. Commentary on van Dongen, et al. in Cochrane Database Syst Rev. Review: low-molecular-weight heparin reduces recurrent venous thromboembolism better than unfractionated heparin. ACP J Club. 2005;142:71.
Dunn AS. Commentary on van Dongen, et al. in Cochrane Database Syst Rev. Review: low-molecular-weight heparin reduces recurrent venous thromboembolism better than unfractionated heparin. Evidence Based Med. 2005;10:80.
Dunn AS. Commentary on Hsieh, et al. in J Adv Nurs. Review: Wearing graduated compression stockings during air travel reduces the risk of deep venous thromboembolism. Evidence Based Med. 2006;11:55.
Dunn AS. Commentary on Touze, et al. in Stroke. Risks for myocardial infarction or nonstroke vascular death after ischemic stroke or transient ischemic attack were each 2% per year. ACP J Club. 2006;145:23.
Dunn AS. Commentary on Le Gal, et al. in Ann Intern Med. The revised Geneva score predicted pulmonary embolism in patients with shortness of breath or chest pain. ACP J Club. 2006;145:25.
Dunn AS. Commentary on Onalan, et al. in Am J Cardiol. Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation. ACP J Club. 2007;147:61.
Dunn AS. Commentary on Anderson, et al. in JAMA. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. ACP J Club. 2008;148:10.
Dunn AS. Commentary on Anderson, et al. in JAMA. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism. Evidence Based Med. 2008;13:117.
Goldenberg J, Asuen I, Jervis R, Markoff B, Dunn AS. In the literature: the latest research you need to know. The Hospitalist; 2008;Oct:11-15.
Dunn AS. Commentary on van Walraven C, et al. in Stroke. Oral anticoagulant therapy safely prevented stroke in older patients with atrial fibrillation. ACP J Club. 2009;151:1.
Dunn AS. AHRQ Case & Commentary. Anticoagulation: Held Too Long. AHRQ WebM&M [serial online]. Available at: http://www.webmm.ahrq.gov/case.aspx?caseID=217. April 2010.
Goldenberg J, Briones A, Craig C, Jervis R, Markoff B, Dunn AS. In the literature: the latest research you need to know. The Hospitalist; 2011;Feb13-18.
Dunn AS. Commentary on Connolly SJ, et al. in New Eng J Med. Apixaban reduced stroke compared with aspirin in adults with atrial fibrillation for whom VKA therapy was unsuitable. ACP J Club. 2011;154:3.
Dunn AS. Commentary on Douma RA, et al. in Ann Int Med. 4 clinical decision rules plus D-dimer testing each had high sensitivity and low specificity for excluding acute pulmonary embolism. ACP J Club. 2011;155:11.
Dunn AS. Commentary on Lankeit, et al. in Circulation. Predictive value of the high-sensitivity troponin T assay and the simplified Pulmonary Embolism Severity Index in hemodynamically stable patients with acute pulmonary embolism: a prospective validation study. ACP J Club. 2012;156:12.
Dunn AS. Commentary on Villanueva, et al. in NEJM. A restrictive transfusion strategy reduced 45-day mortality in patients with acute upper GI bleeding. ACP J Club. 2013;158:6.
Dunn AS. Commentary on Kimmel, et al. in NEJM. Warfarin dosing by genotype did not improve time in therapeutic range. ACP J Club. 2014;160:9.
Dunn AS. Commentary on Nazerian, et al. in NEJM. In suspected PE with Wells score >4 or positive d-dimer, multiorgan ultrasonography had 90% sensitivity for PE, and Companion Commentary on Jimenez, et al in NEJM. A 4-marker model predicted a complicated course in normotensive patients with acute symptomatic PE. ACP J Club. 2014;161:12-13.
Dunn AS. Commentary on Simes, et al. in Circulation. After initial anticoagulation for a first unprovoked venous thromboembolism, aspirin reduced recurrence. ACP J Club. 2015;162:8-9.
Book – Editor
Dunn AS, Kathura N, Klotman P. Essentials of Hospital Medicine: A Practical Guide for Clincians. World Scientific Publishing. Singapore. 2012.
Book Chapters
Malik T, Brod-Miller C, Dunn AS, Edelman L, Feit E, Orbuch M, et al. Physical Diagnostic Signs in Critical Care Medicine. In: Infectious Disease in Critical Care Medicine. Cunha, ed. 1998:67-117.
Jervis R, Dunn AS. Perioperative Management of Oral Anticoagulants and Antiplatelet Agents. In: Inpatient Anticoagulation. Fang, ed. Wiley-Blackwell Publishing. 2011:161-78.
Dunn AS. Hospitalists as Leaders. In: Dunn AS, Kathuria N, Klotman K, eds. Essentials of Hospital Medicine: A Practical Guide for Clinicians. Singapore: World Scientific Publishing; 2012: 3-11.
Jervis R, Dunn AS. Perioperative Management of Oral Anticoagulants. In: Dunn AS, Kathuria N, Klotman K, eds. Essentials of Hospital Medicine: A Practical Guide for Clinicians. Singapore: World Scientific Publishing; 2012: 467-475.
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