Hemostatic and antithrombotic stewardship programs: A toolkit for program implementation

Abstract

Hemostatic and antithrombotic agents are high-risk medications associated with high cost. The importance of anticoagulation stewardship has been recently highlighted by national organizations, but hemostatic stewardship programs remain underutilized. Several established hemostatic and/or antithrombotic stewardship programs have demonstrated a significant impact on the quality and cost of care provided to patients receiving these therapies. This review provides a comprehensive toolkit for development and implementation of combined hemostatic and antithrombotic stewardship programs.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…Another programmatic systems approach to medication management endeavors to create a shared mental model using drug stewardship as a platform of organizational change [ 104 , 105 , 106 , 107 ]. While most stewardship programs have concentrated on rational antimicrobial use [ 108 ], recent developments have focused attention on medication classes that are frequently used in perioperative care and are high-risk for the patient, including opioids [ 109 , 110 , 111 , 112 , 113 ], anticoagulants [ 114 , 115 , 116 , 117 , 118 , 119 , 120 ], anemia management [ 121 , 122 , 123 , 124 , 125 ], and glycemic control with insulin [ 126 , 127 ], among others [ 4 ]. Table 5 summarizes recommendations for preventing VTE, SSI, PONV, POI, and PoD [ 128 ].…”

A call to action for anticoagulation stewardship

“…Unlike conventional anticoagulation management, which is often siloed and focused solely on drug management, anticoagulation stewardship provides a holistic approach that spans the continuum of care, is focused on continuous quality improvement, and addresses patient‐level, clinician level, and system‐level barriers and opportunities to improve patient care. To address the ongoing pervasiveness of inappropriate anticoagulant prescribing and management, a growing number of health care institutions across the United States and globally have successfully implemented anticoagulation stewardship initiatives and assessed their impact in both inpatient and outpatient clinical settings 19–21 …”

“…To address the ongoing pervasiveness of inappropriate anticoagulant prescribing and management, a growing number of health care institutions across the United States and globally have successfully implemented anticoagulation stewardship initiatives and assessed their impact in both inpatient and outpatient clinical settings. [19][20][21] Koolian et al 16…”

Creation of a novel specialty residency in thrombosis and hemostasis management

“…Antithrombotic and hemostatic medications are high-risk therapies that are routinely used for the prevention and treatment of thrombosis and bleeding events. Considering the risk of serious adverse patient outcomes 1 and evidence of high variability in clinical practices, 2 local and national efforts have been undertaken to advance the safety and quality of these essential medications. 3 Considered to be "cutting edge" as recently as the 1990s, 4,5 pharmacist-run warfarin clinics and focused acute care services have been shown to provide superior international normalized ratio management and to improve patient outcomes.…”

“…Antithrombotic and hemostatic medications are high‐risk therapies that are routinely used for the prevention and treatment of thrombosis and bleeding events. Considering the risk of serious adverse patient outcomes 1 and evidence of high variability in clinical practices, 2 local and national efforts have been undertaken to advance the safety and quality of these essential medications 3…”