Adherence to guidelines for the prescribing of double and triple combinations of antithrombotic agents

Herwaarden, Margaretha F. Warlé-van; Roukens, Monique; Pop, Gheorghe; Lamfers, E. J. P.; Smet, Peter A. G. M. De; Kramers, Cornelis

doi:10.1177/2047487312451253

Cited by 8 publications

(13 citation statements)

References 34 publications

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“…These recommendations involve the risk of the patient or healthcare providers overlooking that one of the TARs should be stopped. Our results suggest that erroneous DAPT continuation contributes substantially to guideline non-adherence in primary care, a conclusion that supports the findings of Warlé-van Herwaarden et al 16 DAPT is most frequently initiated in the hospital, for example, after a myocardial infarction or a cerebrovascular accident. This treatment is continued after discharge and should be stopped in the outpatient setting.…”

Section: -20supporting

confidence: 90%

“…These results are in line with the findings of Warlé-van Herwaarden et al, who stated that 24% of patients from a community pharmacy who used DAPT had a deviation from the guidelines. 16 In the study by Warlé-van Herwaarden et al, the prescriber was not contacted, and it was therefore unknown whether the deviations were intentional or erroneous. In the present study, three of the eight patients with an erroneous deviation from the guidelines never had an indication for DAPT, while in five patients one of the two agents should have been stopped in the past.…”

Section: -20mentioning

confidence: 99%

“…14,15 In a study by Warlé-van Herwaarden et al in a Dutch community pharmacy, 24% of all therapies with DAPT were found to not be prescribed in accordance with the guidelines. 16 Nearly half of these nonadhering therapies were a result of DAPT continuation beyond the recommended treatment period. Breuckmann et al found a 38.2% level of compliance with European Society of Cardiology (ESC) guidelines for unstable angina pectoris in German hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Inpatient prescribing of dual antiplatelet therapy according to the guidelines: a prospective intervention study

Moerlie

Uden

Mantel‐Teeuwisse

et al. 2020

Pharm Pract (Granada)

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Background: In dual antiplatelet therapy (DAPT), low-dose acetylsalicylic acid is combined with a P2Y12 inhibitor. However, combining antithrombotic agents increases the risk of bleeding. Guidelines on DAPT recommend using this combination for a limited period of between three weeks and 30 months. This implies the risk of DAPT being erroneously continued after the intended stop date. Objective: The primary objective of this study is to assess the proportion of hospitalized patients treated with DAPT whose treatment deviated erroneously and unintentionally from the guidelines. We also assessed risk factors and the effect of a pharmacist intervention. Methods: All patients admitted to the Spaarne Gasthuis (Haarlem/ Hoofddorp, the Netherlands) who used DAPT between March 25th, 2019, and June 14th, 2019, were, in addition to receiving regular care, reviewed to assess whether their therapy was in line with the guidelines’ recommendation and whether deviations were unintended and erroneous. In the event of an unintended deviation, the pharmacist intervened by contacting the prescriber by phone and giving advice to adjust the antithrombotic therapy in line with the guideline. Results: We included 411 patients, of whom 21 patients (5.1%) had a treatment that deviated from the guidelines. For 11 patients (2.7%), the deviation was unintended and erroneous. The major risk factor for erroneous deviation was the use of DAPT before hospital admission (OR 18.7; 95%CI 4.79–72.7). In patients who used DAPT before admission, 18 out of 58 (31.0%) had a deviation from the guidelines of whom 8 (13.8%) were erroneous. For these eight patients, the pharmacist contacted the prescriber, and in these cases the therapy was adjusted in line with the guidelines. Conclusions: Adherence to the guidelines recommending DAPT was high within the hospital. However, patients who used DAPT before hospital admission had a higher risk of erroneous prescription of DAPT. Intervention by a pharmacist increased adherence to guidelines and may reduce the number of preventable bleeding cases.

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Section: -20supporting

confidence: 90%

Section: -20mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inpatient prescribing of dual antiplatelet therapy according to the guidelines: a prospective intervention study

Moerlie

Uden

Mantel‐Teeuwisse

et al. 2020

Pharm Pract (Granada)

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“…Several studies have evaluated the guideline adherence in patients using antithrombotic medication [16][17][18][19]. Proietti et al and Lip et al found that in patients with atrial fibrillation, 40.9-60.6% received adequate antithrombotic treatment, 6.8-21.7% were overtreated and 52.3-17.3% were undertreated and received no antithrombotic treatment [16,17].…”

Section: Introductionmentioning

confidence: 99%

Unintentional guideline deviations in hospitalized patients with two or more antithrombotic agents: an intervention study

Uden

Broek

Houtenbos

et al. 2021

Eur J Clin Pharmacol

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Purpose Treatment schedules for antithrombotic therapy are complex, and there is a risk of inappropriate prescribing or continuation of antithrombotic therapy beyond the intended period of time. The primary aim of this study was to determine the frequency of unintentional guideline deviations in hospitalized patients. Secondary aims were to determine whether the frequency of unintentional guideline deviations decreased after intervention by a pharmacist, to determine the acceptance rate of the interventions and to determine the type of interventions. Methods We performed a non-controlled prospective intervention study in three teaching hospitals in the Netherlands. We examined whether hospitalized patients who used the combination of an anticoagulant plus at least one other antithrombotic agent had an unintentional guideline deviation. In these cases, the hospital pharmacist contacted the physician to assess whether this deviation was intentional. If the deviation was unintentional, a recommendation was provided how to adjust the antithrombotic regimen according to guideline recommendations. Results Of the 988 included patients, 407 patients had an unintentional guideline deviation (41.2%). After intervention, this was reduced to 22 patients (2.2%) (p < 0.001). The acceptance rate of the interventions was 96.6%. The most frequently performed interventions were discontinuation of an low molecular weight heparin in combination with a direct oral anticoagulant and discontinuation of an antiplatelet agent when there was no indication for the combination of an antiplatelet agent and an anticoagulant. Conclusion A significant number of hospitalized patients who used an anticoagulant plus one other antithrombotic agent had an unintentional guideline deviation. Intervention by a pharmacist decreased unintentional guideline deviations.

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“…5 The expanding complexity of haemostaseology results in high demands on the physician in charge: multimorbidity of older patients and the new diversity of options for OAC available by novel anticoagulant drugs necessitate a careful consideration of benefits and risks of the treatment. 6 The cost pressure on the healthcare system requires an economical use of medical resources. 7 Major efforts are indispensable to provide further scientific evidence to cope with these clinical challenges.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of oral anticoagulation therapy: Rationale and design of the thrombEVAL study programme

Prochaska

Coldewey

Göbel

et al. 2014

Eur J Prev Cardiolog

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Adherence to guidelines for the prescribing of double and triple combinations of antithrombotic agents

Abstract: There is room to further develop adherence to guideline-based prescribing of antithrombotic combination therapies and to improve prescription of gastric protection for patients receiving these high-risk combinations.

Cited by 8 publications

References 34 publications

Inpatient prescribing of dual antiplatelet therapy according to the guidelines: a prospective intervention study

Inpatient prescribing of dual antiplatelet therapy according to the guidelines: a prospective intervention study

Unintentional guideline deviations in hospitalized patients with two or more antithrombotic agents: an intervention study

Evaluation of oral anticoagulation therapy: Rationale and design of the thrombEVAL study programme

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