Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review

Area of Science:

• Pharmacology
• Clinical Medicine
• Evidence-Based Practice

Background:

• Thromboembolic events pose significant risks for patients with atrial fibrillation, prior cerebrovascular accidents, and those undergoing surgery.
• Variations in antithrombotic prescribing guidelines and agent availability contribute to inconsistent clinical practice.
• Non-adherence to prescribing guidelines can lead to increased complications and mortality.

Purpose of the Study:

• To systematically review the extent of antithrombotic overuse and underuse in primary and secondary prevention.
• To assess deviations from established prescribing guideline recommendations.
• To identify determinants of non-adherence to antithrombotic guidelines.

Main Methods:

• Systematic review of quantitative studies published between 2000 and 2021.
• Searches conducted in Medline and EMBASE databases.
• Utilized a modified Hoy's risk of bias assessment tool for study evaluation.

Main Results:

• Evidence from the past decade indicates substantial practice variations in antithrombotic prescribing across hospital and primary care settings.
• Identified clinician and patient-driven factors contributing to non-adherence to guidelines.
• Quantified the degree of deviation from recommended antithrombotic use.

Conclusions:

• Significant overuse and underuse of antithrombotics are prevalent, indicating suboptimal patient care.
• Addressing practice variations requires understanding and mitigating clinician and patient-related barriers to guideline adherence.
• Developing improved methods for measuring antithrombotic overuse/underuse is crucial for enhancing patient safety and outcomes.