Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol

Abstract

IntroductionAntithrombotic therapy carries high risks for patient safety. Antithrombotics belong to the top 5 medications involved in potentially preventable hospital admissions related to medication. To provide a standard for antithrombotic therapy and stress the importance of providing optimal care to patients on antithrombotic therapy, the Landelijke Standaard Ketenzorg Antistolling (LSKA; Dutch guideline on integrated antithrombotic care) was drafted. However, the mere publication of this guideline does not guarantee its implementation. This may require a multidisciplinary team effort. Therefore, we designed a study aiming to determine the influence of hospital-based antithrombotic stewardship on the effect and safety of antithrombotic therapy outcomes during and after hospitalisation.Methods and analysisIn this study, the effect of the implementation of a multidisciplinary antithrombotic team is compared with usual care using a pre-post study design. The study is performed at the Erasmus University Medical Center Rotterdam and the Reinier de Graaf Hospital Delft. Patients who are or will be treated with antithrombotics are included in the study. We aim to include 1900 patients, 950 in each hospital. Primary outcome is the proportion of patients with a composite end point consisting of ≥1 bleeding or ≥1 thrombotic event from the beginning of antithrombotic therapy (or hospitalisation) until 3 months after hospitalisation. Bleeding is defined according to the International Society of Thrombosis and Haemostasis (ISTH) classification. A thrombotic event is defined as any objectively confirmed arterial or venous thrombosis, including acute myocardial infarction or stroke for arterial thrombosis and deep venous thrombosis or pulmonary embolism or venous thrombosis. An economic evaluation is performed to determine whether the implementation of the multidisciplinary antithrombotic team will be cost-effective.Ethics and disseminationThis protocol was approved by the Medical Ethical Committee of the Erasmus University Medical Center. The findings of the study will be disseminated through peer-reviewed journals and presented at relevant conferences.Trial registration numberNTR4887; pre-results.

The effect of hospital-based antithrombotic stewardship on adherence to anticoagulant guidelines

“…This study was a sub-study of a larger antithrombotic stewardship study (S-team study), in which the effect of a multidisciplinary antithrombotic team was evaluated on the safety and efficacy of antithrombotic therapy during hospitalization [ 16 ].…”

“…Clinical rules combine the renal function of the patient with the prescribed drug to assess whether dose adjustments should be made based on the renal function. A detailed description of the procedures during the usual care period can be found in the study protocol [ 16 ].…”

“…The previously published study protocol provides a detailed description of the antithrombotic team [ 16 ]. The intervention consisted of the implementation of a multidisciplinary antithrombotic team.…”

Posttraumatic bleeding reduction by systemic administration of fibrin monomer in thrombolytic therapy

“…Гибель животных оказалась сопоставимой с выраженностью посттравматической кровопотери. Так, объем кровопотери в группе животных 2, получивших стрептокиназу и плацебо, был в 1,5 раза выше, в сравнении с аналогичным показателем в группе животных с плацебо (группа 1), в частности по медиане: 15,4 [12,[8][9][10][11][12][13][14][15][16][17][18][19],2] и 10,1 [4,[3][4][5][6][7][8][9][10][11][12][13][14][15][16]3] % от теоретически рассчитанного объема циркулирующей крови соответственно (рис. 2).…”

“…Наряду с обозначенными выше антикоагулянтами в группу антитромботических препаратов входят и активаторы фибринолиза (стрептокиназа и др. ), использующиеся для проведения тромболизиса [14]. Как известно, фибринолитики, особенно в сочетании с травмой, могут провоцировать массивное кровотечение [15].…”