2.1 Study design and setting
A prospective cohort study was conducted in a large teaching hospital in the Netherlands, Amsterdam (OLVG). Consecutive patients on combined antithrombotic therapy who were hospitalized for any reason, were included. Subsequently, a member of the multidisciplinary ASP proactively evaluated the appropriateness of this combined antithrombotic therapy by assessing proper indication according to local hospital guideline, proper prescription and length of use. In case of doubt, the combined antithrombotic therapy was discussed in the ASP. If needed, an intervention was proposed to the treating physician to ensure efficacy and safe use during and after hospitalization. The multidisciplinary ASP consisted of an internist (vascular), a cardiologist, a (cardiothoracic) surgeon, a hospital pharmacist, a pharmacist technician and a nurse specialist. When needed, a surgeon (vascular) and neurologist could were consulted by ASP.
This study protocol was approved by the local ethics committee “ Advies Commissie Wetenschappelijk Onderzoek-Medisch Ethische Commissie (ACWO-MEC) OLVG hospital. As ASP was implemented for improvement of daily clinical care, no written informed consent was required for the interventions described in this study.