Retrospective review of a novel antithrombotic stewardship program in an Australian intensive care unit

The risk of bleeding and thrombosis is high in critical care settings. Antithrombotic Stewardship (ATS) is an organisational-level intervention which can reduce bleeding and thrombosis in hospitalised patients. However, acceptance for ATS programs on antithrombotic-related care in the critically ill has not been explored.

To explore the acceptance of an ATS program involving a recurring multidisciplinary team (MDT) round within an intensive care unit (ICU). Primary outcomes were rates of ATS recommendation and acceptance. Secondary outcomes were rates of clinically relevant bleeding (CRB) and thrombosis in cases where clinical management was suboptimal within 7 days post ATS review.

A retrospective, cross-sectional audit was conducted at a 400-bed tertiary referral hospital in metropolitan Sydney, Australia between February 2024 and February 2025. Only inpatients within the 13-bed ICU during a round were included.

Twenty-nine meetings were held, resulting in 299 patient reviews, with a mean meeting duration of 20 min (SD 6.4). MDTs occurred where possible, every 1-2 weeks. There was a 35% recommendation and 82% acceptance rate. Most recommendations were treatment changes (87/108 recommendations, 81%). These included VTE prophylaxis initiation (28%), changing VTE prophylaxis drug class (25%), anticoagulant dose change (14%), addition of anticoagulant reversal (9%), change in anticoagulant intensity (5%) and anticoagulant or antiplatelet omission (5%). There were 33 CRB and 15 thrombosis events, most occurred in the absence of detectable clinical error (96%).

Implementing an ATS MDT round within the ICU can prompt changes in treatment. Future comparator studies are needed to explore the impact of ATS on patient health outcomes.