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.