Meador Siena, Dyke Shannon, Togami John, Kuskov Brianna, Burnett Allison E
Inpatient Antithrombosis Stewardship Service, University of New Mexico Hospital, Albuquerque, USA.
Outpatient Antithrombosis Clinic, University of New Mexico Hospital, Albuquerque, USA.
J Thromb Thrombolysis. 2022 Feb;53(2):436-445. doi: 10.1007/s11239-021-02551-y. Epub 2021 Aug 19.
Antithrombotic therapies include anticoagulants and antiplatelet agents. It is increasingly recognized that combined dual antithrombotic (DAT, which consists of an oral anticoagulant and a single antiplatelet) and triple antithrombotic therapies (TAT, which consists of an oral anticoagulant and two antiplatelets) increase bleeding risk. Additionally, the benefit of aspirin for primary prevention has been called into question by a number of randomized controlled trials over the last few years. As such, several recent clinical trials have explored de-escalated antithrombotic regimens that have resulted in less bleeding with similar efficacy. Our study was a retrospective, observational investigation assessing the effect of a systematic antithrombosis stewardship intervention implemented in outpatient, pharmacy-driven antithrombosis clinics on the number of patients receiving potentially inappropriate combined antithrombotic therapy. Pharmacists identified anticoagulation patients on concomitant antiplatelet therapy, assessed for appropriateness, and performed interventions if needed. Of the 875 patients included, 261 (29.8%) were on combined antithrombotic therapy, 48 (18.4%) of which were deemed inappropriate at baseline. By the end of the intervention period, 45 (93%) of these patients had a de-escalation in combined therapy (p < 0.001). We found that a systematic de-escalation protocol led to a significant reduction in patients on inappropriate combined antithrombotic therapy.
抗血栓治疗包括抗凝剂和抗血小板药物。人们越来越认识到，联合双重抗血栓治疗（DAT，由一种口服抗凝剂和一种单一抗血小板药物组成）和三重抗血栓治疗（TAT，由一种口服抗凝剂和两种抗血小板药物组成）会增加出血风险。此外，在过去几年中，多项随机对照试验对阿司匹林用于一级预防的益处提出了质疑。因此，最近的几项临床试验探索了降级抗血栓治疗方案，这些方案在疗效相似的情况下出血较少。我们的研究是一项回顾性观察性调查，评估在门诊药房主导的抗血栓诊所实施的系统性抗血栓管理干预措施对接受潜在不适当联合抗血栓治疗患者数量的影响。药剂师识别接受联合抗血小板治疗的抗凝患者，评估其适当性，并在需要时进行干预。在纳入的875名患者中，261名（29.8%）接受联合抗血栓治疗，其中48名（18.4%）在基线时被认为不适当。到干预期结束时，这些患者中有45名（93%）联合治疗降级（p < 0.001）。我们发现，系统性降级方案导致接受不适当联合抗血栓治疗的患者显著减少。
