Global perspectives on the core elements of Antithrombotic Stewardship in hospital

Anticoagulants are a leading cause of medication-related harm, with bleeding and thrombotic events from suboptimal use causing significant patient morbidity. Antithrombotic Stewardship (ATS) is a coordinated, system-level hospital strategy that can minimise the risk of anticoagulant-related harm. Despite the benefits of ATS, implementation is inconsistent, and qualitative exploration of the real-world experience is limited.

To explore the perspectives of clinicians working in hospital-based anticoagulation management and to identify what they consider as core components of successful ATS programs. A secondary aim was to describe quality indicators used to monitor ATS performance.

Semi-structured interviews were conducted with clinicians working in hospital-based ATS services. Participants were recruited through international thrombosis/haemostasis networks. Interviews were thematically coded. Themes were then mapped to Systems Engineering Initiative for Patient Safety (SEIPS) framework for healthcare facilities.

Sixteen clinicians across six countries participated in the study. Core elements under the SEIPS framework were (i) Organisation: dedicated funding and multidisciplinary support, (ii) Individual: clinician commitment and subject matter expertise, (iii) Tasks/Tools and Technology: proactive identification of high-risk clinical scenarios using electronic tools, referral-based consults, and governance activities including guideline development and education and, (iv) Environment: virtual reporting capabilities, while maintaining a visible presence. Nineteen quality indicators were identified monitoring guideline availability, thrombosis/bleeding events, prescribing, interventions, drug expenditure and patient compliance, but these were not consistently used between facilities.

Successful ATS requires funded, multidisciplinary, expert-led services supported by electronic tools and governance initiatives. The absence of standardised quality indicators highlights the need to develop consensus measures to support ATS implementation.