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. 2022 Sep 25;6(6):e12758.
doi: 10.1002/rth2.12758. eCollection 2022 Aug.

Anticoagulation stewardship: Descriptive analysis of a novel approach to appropriate anticoagulant prescription

Maral Koolian  1   2   3 , Daniel Wiseman  2 , Helen Mantzanis  4 , Nikki Kampouris  4 , Ryan S Kerzner  4 , Susan R Kahn  1   2   3
Affiliations

Anticoagulation stewardship: Descriptive analysis of a novel approach to appropriate anticoagulant prescription

Maral Koolian et al. Res Pract Thromb Haemost. .

Abstract

Background: Anticoagulants are a leading cause of morbidity among hospitalized patients, with prescription errors commonly reported. Literature surrounding anticoagulation stewardship is scarce despite its documented effectiveness in the antimicrobial realm.

Objective: To determine the proportion of accepted recommendations on inappropriate anticoagulant prescriptions suggested by a multidisciplinary anticoagulation stewardship program (ASP).

Methods: We conducted a descriptive cohort study of hospitalized patients using therapeutic anticoagulation at a large Canadian tertiary care center between September 1, 2019, and February 28, 2020. A multidisciplinary ASP, composed of physicians and pharmacists, was implemented on June 1, 2019. Patient-, anticoagulant-, and admission-related characteristics were collected. The primary outcome was the proportion of accepted ASP team recommendations by the prescribing team.

Results: A total of 381 patients were enrolled during the study period, resulting in 553 anticoagulant reviews (1.56 reviews/patient) by the ASP. The most common indications for anticoagulation were atrial fibrillation (n = 276, 72%) and venous thromboembolism (n = 84, 22%). Direct oral anticoagulants were most frequently prescribed (n = 253, 67%), followed by vitamin K antagonists (n = 88, 23%). Among the reviewed prescriptions, 355 of 553 (64%) generated a recommendation; 299 of 355 (84%) recommendations were accepted by the treating team. Dose adjustments were the leading category of recommendations (31%), followed by alerts regarding drug interactions (19%).

Conclusion: Inpatient anticoagulant prescriptions were optimized following recommendations by the ASP team. The most frequent types of prescription changes concerned dose adjustments and drug interactions. Further research is required to assess the effect of an ASP on clinical outcomes.

Keywords: anticoagulants; atrial fibrillation; drug interactions; pharmacist; prescriptions; venous thromboembolism.

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Figures

FIGURE 1
FIGURE 1
Column A depicts the proportions of reviewed prescriptions that required a recommendation (Yes) and those that did not (No). Column B depicts the proportions of acceptance (Yes) and refusals (No) of recommendations
FIGURE 2
FIGURE 2
Proportions of recommendations in various categories are depicted; individual categories are further expanded on in Appendix S1. *VTE, venous thromboembolism
See this image and copyright information in PMC

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