Effect of antithrombotic stewardship on the efficacy and safety of antithrombotic therapy during and after hospitalization.

Albert R Dreijer,Frank W G Leebeek,Jeroen Diepstraten,Peter G M Mol,Suzanne Polinder,Marieke J H A Kruip,Rolf Brouwer,Patricia M L A Van Den Bemt,F Nanne Croles,Esther Kragten,Christophe Leroyer

doi:10.1371/journal.pone.0235048

Albert R Dreijer, Frank W G Leebeek + Show 9 more

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https://doi.org/10.1371/journal.pone.0235048

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Abstract

Although the benefits of antithrombotic drugs are indisputable to reduce thrombotic events, they carry a high risk of compromising patient safety. No previous studies investigated the implementation and (cost-) effectiveness of a hospital-based multidisciplinary antithrombotic team on bleeding and thrombotic outcomes. The primary aim of this study was to compare the proportion of patients with a composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization. A prospective, multicenter before-after intervention study was conducted in two Dutch hospitals. Adult patients hospitalized between October 2015 and December 2017 treated with anticoagulant therapy were included. The primary aim was to estimate the proportion of patients with a composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization. The intervention was the implementation of a multidisciplinary antithrombotic team focusing on education, medication reviews by pharmacists, implementing of local anticoagulant therapy guidelines based on national guidelines, patient counselling and medication reconciliation at admission and discharge. The primary endpoint was analysed using segmented linear regression. We obtained data for 1,886 patients: 941 patients were included in the usual care period and 945 patients in the intervention period. The S-team study showed that implementation of a multidisciplinary antithrombotic team over time significantly reduced the composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization in patients using anticoagulant drugs (-1.83% (-2.58% to -1.08%) per 2 month period). This study shows that implementation of a multidisciplinary antithrombotic team over time significantly reduces the composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization in patients using anticoagulant drugs. Trialregister.nl NTR4887.

Highlights

This study shows that implementation of a multidisciplinary antithrombotic team over time significantly reduces the composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization in patients using anticoagulant drugs
The benefits of antithrombotic drugs are indisputable to reduce thrombotic events, they carry a high risk of compromising patient safety in terms of bleeding [1,2,3,4]
The study population consisted of patients who started with anticoagulant therapy in the hospital, patients who were already treated with anticoagulant therapy before hospitalization and patients who restarted anticoagulant therapy after a surgical or non-surgical intervention

Summary

Introduction

The benefits of antithrombotic drugs are indisputable to reduce thrombotic events, they carry a high risk of compromising patient safety in terms of bleeding [1,2,3,4]. As far as we know, no previous studies investigated the implementation and (cost-) effectiveness of a hospital-based multidisciplinary antithrombotic team on bleeding and thrombotic outcomes. The team focused on education, medication reviews by pharmacists, implementing of local anticoagulant therapy guidelines based on national guidelines, patient counselling and medication reconciliation at admission and discharge [9]. The benefits of antithrombotic drugs are indisputable to reduce thrombotic events, they carry a high risk of compromising patient safety. No previous studies investigated the implementation and (cost-) effectiveness of a hospital-based multidisciplinary antithrombotic team on bleeding and thrombotic outcomes.

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