Department of Pharmacy, the Johns Hopkins Hospitaly, Baltimore, MD, USA.
Division of Hematology, the Johns Hopkins Hospital, Baltimore, MD, USA.
J Pharm Pract. 2023 Dec;36(6):1343-1349. doi: 10.1177/08971900221116185. Epub 2022 Jul 18.
An antithrombotic stewardship program was implemented to reduce IV DTI use and increase fondaparinux and direct oral anticoagulant (DOAC) use for suspected or confirmed Heparin-induced thrombocytopenia (HIT). This study evaluated the impact of an antithrombotic stewardship program on IV DTI utilization in patients with HIT. A retrospective analysis of adults receiving IV DTIs or fondaparinux from July 2016 to July 2017 (pre-stewardship) and October 2017 to July 2019 (post-stewardship) was conducted. The median duration of IV DTI administration was not significantly different in HIT-negative patients between the pre- and post-stewardship cohorts (1.6 days (25th percentile (p25), 75th percentile (p75): .5, 3.3) vs 1.7 days (p25, p75: .9, 3.9), = .31). The median duration of IV DTI administration in HIT-positive patients was 9.9 days (p25, p75: 7.6, 21.0) pre-stewardship and 7.3 days (p25, p75: 4.8, 16.5) post-stewardship ( = .18). For HIT-positive patients, the time from HIT diagnosis to discharge was 12.8 days (p25, p75: 8.9, 24.9) and 9.2 days (p25, p75: 4.0, 18.1) in the pre- and post-stewardship cohorts, respectively ( = .07). Fondaparinux and DOAC prescribing rates were 40.7% and 62.2% in the pre- and post-stewardship cohorts, respectively ( = .09). The percentage of patients with no contraindications to IV DTI alternatives receiving these agents increased from 31.2% to 78.6% ( = .01) following stewardship implementation. Intravenous DTI alternative utilization increased significantly after stewardship implementation. Stewardship implementation was associated with a non-statistically significant trend towards decreased IV DTI utilization and decreased length of stay for HIT-positive patients.
实施了一种抗血栓治疗管理计划，以减少 IV DTI 的使用，并增加依诺肝素和直接口服抗凝剂（DOAC）在疑似或确诊肝素诱导血小板减少症（HIT）患者中的使用。本研究评估了抗血栓治疗管理计划对 HIT 患者中 IV DTI 使用的影响。对 2016 年 7 月至 2017 年 7 月（管理前）和 2017 年 10 月至 2019 年 7 月（管理后）期间接受 IV DTI 或依诺肝素治疗的成年人进行了回顾性分析。在 HIT 阴性患者中，管理前后队列的 IV DTI 治疗中位持续时间无显著差异（1.6 天（25 百分位数（p25），75 百分位数（p75）：0.5，3.3）与 1.7 天（p25，p75：0.9，3.9），=.31）。HIT 阳性患者的 IV DTI 治疗中位持续时间为 9.9 天（p25，p75：7.6，21.0），管理后为 7.3 天（p25，p75：4.8，16.5）（=.18）。对于 HIT 阳性患者，从 HIT 诊断到出院的时间分别为管理前队列的 12.8 天（p25，p75：8.9，24.9）和管理后队列的 9.2 天（p25，p75：4.0，18.1）（=.07）。在管理前后队列中，依诺肝素和 DOAC 的处方率分别为 40.7%和 62.2%（=.09）。有 IV DTI 替代药物使用无禁忌证的患者比例从 31.2%增加到 78.6%（=.01），实施管理后。在实施管理后，IV DTI 替代药物的使用显著增加。管理实施与 HIT 阳性患者 IV DTI 使用率和住院时间减少呈非统计学趋势相关。
