Abstract Number: PB0014
Meeting: ISTH 2020 Congress
Background: Patient population on antithrombotic therapy is growing and the antithrombotic landscape is complex. Combining oral anticoagulants (OAC, e.g. DOAC and VKA) with other antithrombotic agents (platelet aggregation inhibitors, PAI) is associated with high risk of bleeding complications and should be monitored closely to prevent unintentional longer use than indicated. Our hospital has implemented a multidisciplinary antithrombotic stewardship (ASP) to proactively monitor the in-patients safety and efficacy of antithrombotic therapy.
Aims: To determine the number of interventions needed by ASP while monitoring hospitalized patients on combinations of OAC with other antithrombotic agents.
Methods: This prospective, single-center, observational cohort study was conducted in a large teaching hospital between March 2019 and June 2019. Patients using a combination of OAC with PAI (double therapy) or with two PAI’s (triple therapy) during hospitalization were included to be monitored by ASP on indication and length of use. Primary outcome was the number of interventions regarding the antithrombotic therapy initiated by ASP.
Results: The study comprised 200 consecutive patients (table 1), of which 123 patients (61.5%) needed an intervention (58% of double and 78% of triple therapy patients). Interventions most initiated were ‘define maximum duration of use’ (62%) and ‘discontinue PAI’ (24%). For patients started the antithrombotic combination during hospitalization most needed intervention was to ‘define maximum duration of use of the combined antithrombotic therapy’ before discharge (70%, n=80), while the intervention needed for those who entered the hospital using a combination of antithrombotic agents was to stop one or two PAI’s as the combination was no longer indicated (46%, n=43) (table 2).
Conclusions: Hospitalized patients using an OAC combined with other antithrombotic agents often need an intervention to prevent unnecessary longer use than indicated. Implementation of APS leads to interventions in 61.5% of these hospitalized patients and therefore improves safety and efficacy of antithrombotic medication.
| Characteristic | Double antithrombotic therapy (n=160) | Triple antithrombotic therapy (n=40) |
| Male gender n, (%) | 100 (62.5) | 100 (62.5) |
| Age, year [range] | 73 [36-95] | 71 [38-87] |
| Length of hospitalization, days [range] | 12 [1-77] | 15 [2-82] |
| Cardiac ward type n, (%) | 94 (58.8) | 37 (92.5) |
| Combination newly started during hospitalization, n (%) | 102 (63.8) | 32 (80.0) |
| VKA combined with PAI n, (%) | 73 (45.6) | 19 (40.0) |
| DOAC combined with PAI n, (%) | 77 (48.1) | 19 (40.0) |
| LMWH combined with PAI n, (%) | 10 (6.3) | 2 (5.0) |
| Death during hospitalization, n (%) | 5 (3.1) | 1 (2.5) |
[Table 1. Baseline characteristics of patients using double and triple antithrombotic therapy and reviewed by ASP.]
| Type of intervention | Number of patients using double or triple antithrombotic therapy started during hospitalization (n = 80) (%) | Number of patients using double or triple antithrombotic therapy not started during hospitalization (n = 43) (%) |
| Define maximum date of use | 56 (70) | 20 (46.5) |
| Discontinue PAI | 9 (11.3) | 20 (46.5) |
| Discontinue OAC | 3 (3.8) | 1 (2.3) |
| Add PAI | 1 (1.3) | 1 (2.3) |
| Add LMWH | 1 (1.3) | 0 (0) |
| Other | 10 (0) | 1 (2.3) |
[Table 2. Comparison of interventions of patients with double or triple therapy started during current hospitalization vs started not within current]
To cite this abstract in AMA style:
van der Veer M, Schroeder-Tanka J, van Wissen S, Khorsand N. Interventions Needed in Antithrombotic Therapy in a Real Life Hospitalized Population; Evaluation of Interventions Initiated by a Multidisciplinary Antithrombotic Team Regarding Antithrombotic Agent Combinations in In-Patient Care [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/interventions-needed-in-antithrombotic-therapy-in-a-real-life-hospitalized-population-evaluation-of-interventions-initiated-by-a-multidisciplinary-antithrombotic-team-regarding-antithrombotic-agent-c/. Accessed September 24, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/interventions-needed-in-antithrombotic-therapy-in-a-real-life-hospitalized-population-evaluation-of-interventions-initiated-by-a-multidisciplinary-antithrombotic-team-regarding-antithrombotic-agent-c/