Implementation and impact of a multidisciplinary coagulation factor stewardship program at an academic medical center

Waheed, Anem; Fongemie, Justin; Gopal, Srila; Esham, Kimberly S; Richardson-Weber, Leslie; Zhang, Lulu; Doren, Layla Van; Buchsbaum, Rachel J.; Comenzo, Raymond L.

doi:10.1007/s11239-020-02071-1

Cited by 4 publications

(10 citation statements)

References 5 publications

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“…29 Although use before and after stewardship was similar, there was a total semiannual cost savings of $101,736. 29…”

Section: Discussionmentioning

confidence: 99%

“…28 Lastly, Waheed et al in 2020 investigated preand post-protocol changes with the involvement of a hematology consult to guide the appropriate use of off-label 4-factor PPC and rFVIIa. 29 Although use before and after stewardship was similar, there was a total semiannual cost savings of $101,736. 29 There were several limitations to this study.…”

Section: Discussionmentioning

confidence: 99%

“…29 Although use before and after stewardship was similar, there was a total semiannual cost savings of $101,736. 29 There were several limitations to this study. The post-protocol period of four months resulted in a small sample size.…”

Section: Discussionmentioning

confidence: 99%

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Alternative Factor Prescribing after Low-Dose Recombinant Factor VIIa Protocol in Cardiac Surgery

Momenzadeh

Meyer

Leon

et al. 2022

Preprint

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BackgroundSafety concerns exist with the off-label use of recombinant factor VIIa (rFVIIa, Novoseven RT®) for refractory bleeding in cardiac surgery, including increased risk of thromboembolism. A rFVIIa protocol was implemented in December 2015 to standardize rFVIIa for cardiac surgery related hemorrhage.MethodsWe performed a retrospective, observational review of rFVIIa in adult cardiac surgery patients pre-protocol (January 2015 to November 2015) vs. post-protocol (December 2015 to March 2016). Study outcomes were rate of rFVIIa administration, rFVIIa dosing characteristics, length of stay, mortality, readmission rate, need for re-exploration, and rate of 4-factor Prothrombin Complex Concentrates (PCC; Kcentra®) administration.ResultsThere was a significant reduction in percentage of cardiac surgery cases receiving rFVIIa pre-vs. post-protocol (14.3 vs. 5.2%, p=0.015). Average total dose per patient decreased between groups (81.4 vs. 56.6 mcg/kg, p=0.059). In-hospital mortality, length of stay, need for re-exploration, readmission rates and 30-day mortality did not differ. Although 4-four-factor PCC significantly increased post-protocol (2.5% vs. 8%, p=0.02), overall use of factor products, rFVIIa or 4-factor PCC, did not change between study periods (16.8% vs. 13%, p=0.416). Mean cost of either rFVIIa or 4-factor PCC pre-protocol was significantly higher than that post-protocol ($8,778 vs. $4,421, p=0.0008).ConclusionsThe use of rFVIIa decreased after implementation of a rFVIIa protocol targeting 30 mcg/kg/dose without compromising morbidity or mortality outcomes. Four-factor PCC use significantly increased during the study, but the overall cost was reduced. Institutions wanting to implement a rFVIIa protocol should take careful measures to concurrently address off-label use of 4-factor PCC.

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“…29 Although use before and after stewardship was similar, there was a total semiannual cost savings of $101,736. 29…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Alternative Factor Prescribing after Low-Dose Recombinant Factor VIIa Protocol in Cardiac Surgery

Momenzadeh

Meyer

Leon

et al. 2022

Preprint

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“…Several publications have highlighted the impact of Hemostatic and Antithrombotic Stewardship Programs (Table 1). 9‐18 Of the 10 stewardship programs with reported outcomes, four programs had initiatives only focused on anticoagulation stewardship, four programs only focused on hemostatic stewardship, and two programs had a combination of select interventions involving anticoagulation and hemostatic stewardship. Reported anticoagulation interventions primarily involve anticoagulant prescribing and institutional protocol adherence, as well as focused efforts on heparin‐induced thrombocytopenia (HIT) management to reduce intravenous direct thrombin inhibitor (IV DTI) use 9‐12,17,18 .…”

Section: Existing Hemostatic And/or Antithrombotic Stewardship Progra...mentioning

confidence: 99%

“…Reported anticoagulation interventions primarily involve anticoagulant prescribing and institutional protocol adherence, as well as focused efforts on heparin‐induced thrombocytopenia (HIT) management to reduce intravenous direct thrombin inhibitor (IV DTI) use 9‐12,17,18 . Other programs aimed at the optimization of CFC use have reported optimization of patient selection for prothrombin complex concentrate (PCC) administration for anticoagulation reversal, preferential use of activated prothrombin complex concentrate (aPCC) over recombinant factor VIIa (rFVIIa) for hemophilia patients with inhibitors, CFC formulary management, implementation of 340B Drug Pricing Program for CFCs, and continuous infusion CFC administration 13‐16 . Notably, across all programs, pharmacists have been essential to program development and in most cases are heavily involved in direct patient care for patients receiving anticoagulants and CFCs.…”

Section: Existing Hemostatic And/or Antithrombotic Stewardship Progra...mentioning

confidence: 99%

Hemostatic and antithrombotic stewardship programs: A toolkit for program implementation

Dane

Naik²,

Streiff³

et al. 2022

J Am Coll Clin Pharm

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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.

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Creation of a novel specialty residency in thrombosis and hemostasis management

Inglis

Triller²,

Burnett

et al. 2022

J Am Coll Clin Pharm

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Antithrombotic and hemostatic medications are essential, yet high‐risk therapies commonly used for the prevention and treatment of thrombosis and bleeding. Since first demonstrating the ability to improve the safety and quality of heparin and warfarin‐related care many years ago, pharmacists now play an important expanded role in more comprehensive and complex thrombosis and hemostasis management programs. Such programs encompass the prevention and treatment of thrombosis and bleeding across care settings, medical indications, and professional services. These programs impact not only appropriate use of antithrombotic medications, but also of antidotes, blood products, medical devices, laboratory testing, and other important aspects of care. In addition to providing direct patient care, pharmacists are increasingly involved in the development and implementation of system‐level processes and quality improvement activities that require technical knowledge, leadership skills, and effective multidisciplinary collaboration. Evolution in health care regulation and accreditation standards, along with national efforts to advance the concept of Anticoagulation Stewardship, will likely accelerate the growth and expansion of thrombosis and hemostasis management programs, increasing the demand for well‐trained and experienced clinical pharmacists. However, none of the existing accredited specialty pharmacy residency programs encompasses the full range of skills and experiences necessary for new pharmacists to practice effectively in this complex and rapidly evolving field. This manuscript describes the evolution of the Hemostasis and Antithrombotic Stewardship program at Brigham and Women's Hospital and the development of a novel postgraduate year 2 (PGY2) pharmacy residency in this specialty area. It provides details of the new PGY2 residency program curriculum and puts forth a vision of success for such programs at the local and national levels.

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Implementation and impact of a multidisciplinary coagulation factor stewardship program at an academic medical center

Cited by 4 publications

References 5 publications

Alternative Factor Prescribing after Low-Dose Recombinant Factor VIIa Protocol in Cardiac Surgery

Alternative Factor Prescribing after Low-Dose Recombinant Factor VIIa Protocol in Cardiac Surgery

Hemostatic and antithrombotic stewardship programs: A toolkit for program implementation

Creation of a novel specialty residency in thrombosis and hemostasis management

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