The effect of hospital-based antithrombotic stewardship on adherence to anticoagulant guidelines
Albert R Dreijer1,2, Jeroen Diepstraten3, Frank W G Leebeek4
1Department of Hospital Pharmacy, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. a.dreijer@erasmusmc.nl.
Insights
Implementing a multidisciplinary antithrombotic team improved physician adherence to anticoagulant guidelines. This stewardship enhanced the correct dosing of low-molecular-weight-heparins, reducing potential complications.
Area of Science:
- Pharmacology
- Clinical Medicine
- Healthcare Management
Background:
- Anticoagulant therapy carries a high risk of complications, often due to suboptimal adherence to treatment protocols.
- Physician adherence to anticoagulant guidelines is crucial for minimizing these risks.
Purpose of the Study:
- To evaluate the impact of hospital-based multidisciplinary antithrombotic stewardship on physician adherence to anticoagulant guidelines.
- To assess whether a dedicated team improves adherence to established anticoagulant therapy protocols.
Main Methods:
- A prospective, non-randomized before-and-after study in two Dutch hospitals involving 1886 patients treated with anticoagulant therapy.
- Implementation of a multidisciplinary antithrombotic team focused on education, medication reviews, protocol development, patient counseling, and reconciliation.
- Primary outcome measured was physician adherence to anticoagulant guidelines.
Main Results:
- Physician adherence to anticoagulant guidelines was significantly higher during the intervention period (ORadj 1.58, 95% CI 1.21-2.05).
- The improved adherence was primarily driven by better dosing of low-molecular-weight-heparins (LMWHs).
- The study included 941 patients in the usual care period and 945 in the intervention period.
Conclusions:
- Multidisciplinary antithrombotic stewardship significantly enhances physician adherence to anticoagulant guidelines.
- Improved dosing of low-molecular-weight-heparins is a key factor contributing to increased overall adherence.
- This approach offers a viable strategy for optimizing anticoagulant therapy and patient safety.
Abstract:
Background Anticoagulant therapy is associated with a high risk of complications. Adherence to anticoagulant therapy protocols may lower this risk but adherence is often suboptimal. The introduction of a multidisciplinary antithrombotic team may improve adherence to anticoagulant guidelines among physicians. Objective To determine the effect of hospital-based multidisciplinary antithrombotic stewardship on adherence to anticoagulant guidelines among prescribing physicians. Setting This prospective non-randomised before-and-after study was conducted in patients hospitalized between October 2015 and December 2017 and treated with anticoagulant therapy. Method A multidisciplinary antithrombotic team focusing on education, medication reviews, drafting of local anticoagulant therapy protocols, patient counseling and medication reconciliation at admission and discharge was implemented in two Dutch hospitals. Main outcome measure Primary outcome was the proportion of the admitted patients in which the prescribing physician did adhere to the anticoagulant guidelines. Results The study comprised 1886 patients, of which 941 patients were included in the usual care period and 945 patients in the intervention period. Multivariable logistic regression analysis indicated that adherence was observed significantly more often during the intervention period (adjusted odds ratio [ORadj] 1.58, 95% confidence interval [95% CI] 1.21-2.05). Detailed analysis identified that the significantly higher overall adherence in the intervention period was attributed to dosing of LMWHs (odds ratio [OR] 1.58, 95% CI 1.16-2.14). Conclusion This study shows that introduction of a multidisciplinary antithrombotic stewardship leads to a significantly higher overall adherence to anticoagulant guidelines among prescribing physicians, mainly based on the improvement of dosing of low-molecular-weight-heparins.
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