It's time to improve antithrombotic therapy! A global perspective for antithrombotic stewardship

Antithrombotic drugs are a class of medications with the highest rates of serious and life-threatening adverse events, many of which are preventable with proper knowledge and systems of management. Antithrombotic stewardship is a care model shown to improve outcomes and is gaining traction throughout the world. Stewardship implies a comprehensive system of care employing coordinated, efficient, and sustainable initiatives designed to achieve optimal anticoagulant-related health outcomes and minimize avoidable adverse drug events. Numerous studies from Europe, Asia and elsewhere document the high rate of adverse events associated with prescribing errors, problems of adherence, inappropriate concomitant therapy, and poor follow up. The challenge with antithrombotic stewardship on a global basis is that no single model is applicable to all countries. This manuscript summarizes recent data from a wide range of countries documenting poor outcomes with antithrombotic care, describes the nature and elements of a stewardship program, and advocates for the implementation of such programs, within the context of different country-specific healthcare delivery systems and healthcare cultures.