Abstract Number: PB2452
Meeting: ISTH 2020 Congress
Background: Anticoagulants are a leading cause of morbidity among hospitalized patients. The advent of direct oral anticoagulants (DOACs) has led to further occasions for prescribing errors, thus adverse events. Literature describing the effect of antithrombotic stewardship programs (ASP) is scarce, despite the vast breadth of data demonstrating effectiveness the antibiotic realm. We hypothesize that the implementation of a multidisciplinary ASP leads to more appropriate anticoagulant prescriptions.
Aims: To determine the effect of a multidisciplinary ASP on anticoagulant prescription among inpatients in a Canadian tertiary care center. Secondary outcomes include the incidence of bleeding, thromboembolism, mortality during hospital stay, and length of stay.
Methods: We performed a retrospective cohort study of all patients prescribed therapeutic anticoagulants on select hospital units between September 1st, 2019 and January 31st 2020, at the Jewish General Hospital in Montreal, Canada. Our ASP was implemented on June 1st, 2019. Patient-, anticoagulant-, admission- related characteristics were collected. Effect of ASP was measured as the proportion of adjusted prescriptions following a recommendation by the team. Recommendations in compliance with Canadian best practice guidelines were made if prescriptions were suboptimal; they were grouped into descriptive categories.
Results: A total of 447 inpatients were prescribed therapeutic anticoagulation during the study period. Among them, 301/447 (67%) required a recommendation; 247/301 (82.1%) led to an adjustment. The total proportion of adjusted prescriptions was 247/447 (55%). The most frequent types of recommendations were warfarin dose adjustment (18%), laboratory test orders (13.3%), and DOAC dose adjustment (9%).
Conclusions: The implementation of an antithrombotic stewardship program leads to optimization of anticoagulant prescriptions. Further research measuring the effect of such programs on clinical outcomes such as bleeding and thromboembolism is needed.
To cite this abstract in AMA style:Koolian M, Kerzner R, Kampouris N, Mantzanis H, Kahn SR. Antithrombotic Stewardship: A Novel Approach to Appropriate Anticoagulant Prescription [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/antithrombotic-stewardship-a-novel-approach-to-appropriate-anticoagulant-prescription/. Accessed October 1, 2023.
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