1. Introduction
Antithrombotic therapy such as antiplatelet drugs and oral
anticoagulation (OAC) are used extensively to treat and prevent
thromboembolic events by inhibiting platelet aggregation and
coagulation. OAC (vitamin K-antagonist (VKA, coumarines) and direct oral
anticoagulation (DOAC) therapy) is recommended for the prevention of
stroke in patients with atrial fibrillation (AF) and systemic embolism,
while antiplatelet therapy (platelet aggregation inhibitors (PAI) such
as acetylsalicylic acid and P2Y12 inhibitors) is recommended for the
prevention of (recurrent) myocardial infarction and stent thrombosis.
The patient population on antithrombotic therapy is growing and the
antithrombotic landscape is complex. In clinical practice, a subgroup of
patients have an indication for both OAC and antiplatelet therapy.1-4 However, combining OAC with other antithrombotic
agents is associated with a high risk of bleeding complications.5,6 In addition, the complexity of guidelines and
schedules for combined antithrombotic therapy could cause unnecessarily
prolonged continuation of this combined therapy. Due to this complexity,
medication errors may occur. 7-11 In fact,
antithrombotics are the most common cause of potentially avoidable
adverse events that result in a prolonged hospitalisation compared to
other medications. 12-14 For these reasons, combined
antithrombotic therapy should be monitored closely to prevent
unintentional longer use than indicated, avoidable bleeding
complications and unnecessary (re)hospitalizations. Therefore, our
hospital has implemented a multidisciplinary antithrombotic stewardship
(ASP) to proactively monitor the in-patients safety and efficacy of
daily antithrombotic therapy use.
The main objective of this study is to determine the efficacy of the ASP
by assessing the number of patients on combined antithrombotic therapy
for whom one or more interventions are needed by ASP to optimize the
antithrombotic therapy. Secondarily, reasons for intervention are
explored. Furthermore, we aim to describe the safety outcomes such as
bleeding and thromboembolic complications in patients on combined
antithrombotic therapy.