Management of combined oral antithrombotic therapy by an antithrombotic
stewardship program: a prospective study
Abstract
Aims: Given the complexity of antithrombotic therapy guidelines
especially in patients with combined antithrombotic therapy, there is a
risk of inappropriate prescribing and medication errors. In order to
prevent this, a multidisciplinary antithrombotic stewardship (ASP) is
implemented in our hospital. The primary aim of this study is to
determine the efficacy of this ASP by assessing the number of patients
on combined antithrombotic therapy for whom one or more interventions
are needed. Methods: A prospective cohort study in a large teaching
hospital is conducted. Hospitalized patients who received combined
antithrombotic therapy in which an oral anticoagulant was combined with
one (double therapy) or two (triple therapy) platelet aggregation
inhibitors were included. The ASP proactively evaluated the
appropriateness of this combined antithrombotic therapy. If needed, ASP
improved the concerned therapy. Each improvement measurement by ASP was
counted as one intervention. Results: A total of 460 patients were
included over a period of 12 months. 251 (54.6%) patients required at
least one intervention from the ASP. The most common intervention was to
define and document a maximum duration of the combined antithrombotic
therapy (65.5%) instead of lifetime use of the combination, to
discontinue antithrombotic therapy (19.4%) as the proper indication was
lacking and to adjust the dosage (8.1%). Conclusion: As intervention
was needed in more than half of the patients on combined antithrombotic
therapy, it seems essential to implement an ASP that dedicated evaluates
antithrombotic therapy to improve and ensure optimal use and medication
safety.