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Implementation of a Hemostatic and Antithrombotic Stewardship program.

David P Reardon1, Julie K Atay, Stanley W Ashley

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Implementing a Hemostatic and Antithrombotic (HAT) Stewardship program improves patient care and reduces costs. This specialized service optimizes the use of high-risk HAT agents, minimizing adverse events and enhancing therapy management.

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Area of Science:

  • Pharmacology
  • Hematology
  • Health Services Research

Background:

  • Hemostatic and antithrombotic (HAT) agents are critical but high-risk medications requiring careful management.
  • Inadequate monitoring and dose titration of HAT agents can lead to thrombosis or bleeding complications.
  • Existing therapy management often presents gaps, impacting patient outcomes and healthcare costs.

Purpose of the Study:

  • To implement and evaluate a Hemostatic and Antithrombotic (HAT) Stewardship program.
  • To optimize the use of HAT agents, reduce adverse events, and control costs.
  • To improve clinical surveillance and management of patients on complex anticoagulation therapies.

Main Methods:

  • Established a daily interdisciplinary HAT Stewardship team (pharmacist, hematology attending, medical director).
  • Focused on specialized areas: heparin-induced thrombocytopenia (HIT), hemophilia with inhibitors, ECMO anticoagulation, and mechanical cardiac assist devices.
  • Provided real-time clinical surveillance and management of HAT agents.

Main Results:

  • Demonstrated significant improvements in patient care.
  • Achieved a positive economic impact, with cost savings exceeding program costs nearly sixfold.
  • Successfully optimized the appropriate use of HAT agents and minimized serious adverse events.

Conclusions:

  • A HAT Stewardship program effectively enhances patient outcomes and safety.
  • Implementing such a program leads to substantial cost savings and improved therapy management.
  • Other institutions should consider establishing HAT Stewardship to maximize patient benefits and minimize risks.