Safe and effective anticoagulation use: case studies in anticoagulation stewardship

Abstract

Anticoagulant use is prevalent and associated with significant potential for harm. Anticoagulation stewardship practice has emerged to address care gaps and promote safe, effective, and cost-conscious anticoagulation use across health care systems. We present 4 patient cases describing common challenges in anticoagulation management: inappropriate dosing of direct oral anticoagulants, the diagnosis and management of heparin-induced thrombocytopenia, periprocedural anticoagulation management, and heavy menstrual bleeding on anticoagulation. We discuss available examples of successful stewardship programs that can address the challenges of each case, demonstrating how an investment in anticoagulation stewardship can improve patient outcomes.

Keywords: anticoagulation; atrial fibrillation; heavy menstrual bleeding; ischemic stroke; thrombosis.

Figure 1:

United States Emergency Department visits for medication harms Abbreviation: ADE, adverse drug events; ED, emergency department Data collected from Budnitz et al and Shehab et al. Figure modified from Burnett et al with permission. *Estimates from 2017–2019 include ED visits for medication harms from therapeutic use only, while all subsequent time periods include ED visits for medication harms overall.

Figure 2:

Overview of the four case topics, the care problem the case represents, and examples of anticoagulation stewardship to improve care DTI, direct thrombin inhibitor; IV, intravenous