Abstract

Background Anticoagulant therapy is associated with a high risk of complications. Adherence to anticoagulant therapy protocols may lower this risk but adherence is often suboptimal. The introduction of a multidisciplinary antithrombotic team may improve adherence to anticoagulant guidelines among physicians. Objective To determine the effect of hospital-based multidisciplinary antithrombotic stewardship on adherence to anticoagulant guidelines among prescribing physicians. Setting This prospective non-randomised before-and-after study was conducted in patients hospitalized between October 2015 and December 2017 and treated with anticoagulant therapy. Method A multidisciplinary antithrombotic team focusing on education, medication reviews, drafting of local anticoagulant therapy protocols, patient counseling and medication reconciliation at admission and discharge was implemented in two Dutch hospitals. Main outcome measure Primary outcome was the proportion of the admitted patients in which the prescribing physician did adhere to the anticoagulant guidelines. Results The study comprised 1886 patients, of which 941 patients were included in the usual care period and 945 patients in the intervention period. Multivariable logistic regression analysis indicated that adherence was observed significantly more often during the intervention period (adjusted odds ratio [ORadj] 1.58, 95% confidence interval [95% CI] 1.21–2.05). Detailed analysis identified that the significantly higher overall adherence in the intervention period was attributed to dosing of LMWHs (odds ratio [OR] 1.58, 95% CI 1.16–2.14). Conclusion This study shows that introduction of a multidisciplinary antithrombotic stewardship leads to a significantly higher overall adherence to anticoagulant guidelines among prescribing physicians, mainly based on the improvement of dosing of low-molecular-weight-heparins.

Highlights

  • Anticoagulant therapy is associated with a high risk of complications [1,2,3]

  • Multidisciplinary antithrombotic stewardship can play an important role in the improvement of adherence to anticoagulant guidelines among prescribing physicians

  • After adjustment for the possible predictors, the adjusted Odds ratios (OR) was 1.58

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Summary

Introduction

Guidelines and protocols are developed to improve prescribing quality and patient outcomes, and to reduce variation in clinical practice [6]. Proietti and colleagues assessed adherence in a cohort of atrial fibrillation (AF) acutely admitted patients. They concluded that only 40.9% of the patients were treated according to the European Society of Cardiology (ESC) guideline and guideline-adherent treatment was independently associated with a significantly lower risk of all-cause and cardiovascular (CV) death [12]. Adherence to anticoagulant therapy protocols may lower this risk but adherence is often suboptimal. The introduction of a multidisciplinary antithrombotic team may improve adherence to anticoagulant guidelines among physicians

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