The Current Landscape of Anticoagulation Stewardship Implementation in the United States and Around the World: An...

Little is known about the familiarity and implementation of anticoagulation (AC) stewardship on a global scale. Therefore, we aimed to identify current AC stewardship patterns globally.

An international survey was electronically distributed to individuals involved with AC as a practitioner, researcher, or administrator between June and September 2024.

A total of 985 responses (790 United States [U.S.]/195 non-U.S.) representing 65 countries/regions and 50 U.S. states. Most respondents were physicians (51.9%) or pharmacists (24.2%). 93.7% felt AC safety was a serious concern in their country; 90.5% were at least moderately familiar with the term AC stewardship. Only 52.1% have an AC stewardship program for hospitalized, ambulatory, or both patient populations. Most (73.4%) felt their organization does a good job implementing clinical guidelines/protocols for AC stewardship, most commonly for direct oral anticoagulants (DOACs) (37.0%), low molecular weight heparin (LMWH) (36.5%), intravenous unfractionated heparin (IV UFH) (35.9%), and warfarin (34.3%). Most commonly tracked quality measures were AC reversal (38.5%), rates of major bleeding (33.1%), number of international normalized ratios (INRs) > 5 (32.8%), and warfarin time in therapeutic range (31.4%). 82.2% felt their organization's leadership supports AC stewardship with dedicated resources, including dedicated time to complete AC stewardship (51.1%), dedicated AC stewardship positions (56.5%), and financial support for training (36.3%).

Respondents were familiar with the term AC stewardship, and many organizations have a supportive leadership structure in place for AC stewardship activities, but only half of the respondents felt they have an AC stewardship program in place. Many organizations have not implemented systematic care that includes the use of common clinical guidelines or protocols, and they are not tracking common quality measures. Opportunities exist for further development of AC stewardship services worldwide.