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van Uden RCAE, Sulaiman B, Pols PAM, Meijer K, van den Bemt PMLA, Becker ML. Antithrombotic Questionnaire Tool for Evaluation of Combined Antithrombotic Therapy in Community Pharmacies. J Patient Saf 2024; 20:404-409. [PMID: 38920416 DOI: 10.1097/pts.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVE The objective of this paper is to assess the diagnostic value of an antithrombotic questionnaire tool compared with the hospital's medical record information tool. The hypothesis of this study was that the antithrombotic questionnaire tool could identify patients with potentially incorrect antithrombotic therapy. METHODS This cross-sectional study was conducted in eight community pharmacies in the Netherlands. A standardized questionnaire was developed as antithrombotic questionnaire tool. The pharmacist assessed whether the antithrombotic therapy was correct or potentially incorrect based on answers given by patients and based on the medical record. The primary outcome of the study was the sensitivity and specificity of the antithrombotic questionnaire tool to identify patients with potentially incorrect antithrombotic therapy. RESULTS For 95 patients, the pharmacist assessed that in 81 (85%) the antithrombotic therapy was correct and in 14 (15%) potentially incorrect. Based on the medical record, 86 patients (91%) were assessed as correct and 9 (9%) as potentially incorrect. The sensitivity of the tool was 100% and the specificity 94%. CONCLUSIONS This study demonstrated that the antithrombotic questionnaire tool is a suitable tool to assess whether the patient's antithrombotic therapy is potentially incorrect. It can be applied to identify patients with potentially incorrect antithrombotic therapy.
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Affiliation(s)
| | - Barzo Sulaiman
- From the Pharmacy Foundation of Haarlem Hospitals, Haarlem, the Netherlands
| | | | - Karina Meijer
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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2
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van Paassen JG, Tan JP, Deneer VHM, Bouvy ML. Exploring the pharmacists' role in optimising antithrombotic therapy in primary care: a qualitative study. BMJ Open 2024; 14:e079018. [PMID: 38508648 PMCID: PMC10952980 DOI: 10.1136/bmjopen-2023-079018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE In antithrombotic therapy, the balance between efficacy and safety is delicate, which makes it challenging for healthcare professionals, including pharmacists, to optimise therapy. Pharmacists may play an important role in optimising antithrombotic therapy, but especially in primary care, this role has not been elucidated. Here, we study how community pharmacists (pharmacists in primary care) perceive their current and future role in antithrombotic therapy. DESIGN We conducted a qualitative study using semi-structured interviews. The interview protocol and subsequent analysis were based on the Theoretical Domains Framework, and the findings were interpreted with the Capability Opportunity Motivation - Behaviour System. SETTING AND PARTICIPANTS The interview participants were community pharmacists, located across the Netherlands, from the Utrecht Pharmacy Practice network for Education and Research. RESULTS We interviewed 16 community pharmacists between February and August 2021 and identified several major themes which were important for the pharmacist's role in antithrombotic therapy. Pharmacists felt responsible for the outcome of antithrombotic treatment and intended to invest in their role in antithrombotic therapy. Pharmacists did, however, experience barriers to their role in antithrombotic therapy, like a lack of access to clinical information such as the indication of antithrombotic treatment and a lack of specific knowledge on this treatment. CONCLUSION Community pharmacists perceive a role for themselves in antithrombotic therapy. To fulfil this role, several preconditions must be met.
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Affiliation(s)
- Jacqueline G van Paassen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Jaïr P Tan
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Vera H M Deneer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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3
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Zhang ZX, Schroeder-Tanka J, Stooker W, Wissen S, Khorsand N. Management of combined oral antithrombotic therapy by an Antithrombotic Stewardship Program: a prospective study. Br J Clin Pharmacol 2022; 88:4092-4099. [PMID: 35384015 DOI: 10.1111/bcp.15346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS Antithrombotic management initiatives could prevent inappropriate prescribing and improve patient outcomes especially in patients on combined antithrombotic therapy. To investigate this, a multidisciplinary antithrombotic stewardship program (ASP) was implemented in our hospital. The primary aim of this study was to determine the efficacy of this ASP by assessing the number of patients on combined antithrombotic therapy for whom one or more interventions were needed. METHODS A prospective cohort study in a large teaching hospital was conducted. Hospitalized patients were included who received combined antithrombotic therapy in which an oral anticoagulant was combined with one (double therapy) or two (triple therapy) platelet aggregation inhibitors. The ASP proactively evaluated the appropriateness of this combined antithrombotic therapy. If needed, ASP improved the concerned therapy. Each improvement measurement recommended by the ASP was counted as one intervention. RESULTS A total of 460 patients were included over a period of 12 months. 251 (54.6%) patients required at least one intervention from the ASP. The most common interventions were: 1) to define and document the maximum duration of the combined antithrombotic therapy needed instead of lifetime use of the combination (65.5%), 2) to discontinue antithrombotic therapy as the proper indication was lacking (19.4%), and 3) to adjust the dosage (8.1%). CONCLUSION An intervention was needed in more than half of the patients on combined antithrombotic therapy. Implementation of an dedicated ASP evaluating combined antithrombotic therapy improves the use and safety of antithrombotic medication.
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Affiliation(s)
| | | | - Wim Stooker
- Department of Cardiothoracic Surgery, Department of Intensive Care, OLVG, Amsterdam, The Netherlands
| | - Sanne Wissen
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
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4
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van Uden RCAE, van den Broek MPH, Houtenbos I, Jaspers TCC, Harmsze AM, Kingma HJ, Odekerken DAM, Meijer K, van den Bemt PMLA, Becker ML. Unintentional guideline deviations in hospitalized patients with two or more antithrombotic agents: an intervention study. Eur J Clin Pharmacol 2021; 77:1919-1926. [PMID: 34319470 PMCID: PMC8585825 DOI: 10.1007/s00228-021-03185-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022]
Abstract
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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Affiliation(s)
- Renate C A E van Uden
- Pharmacy Foundation of Haarlem Hospitals, Haarlem, The Netherlands.
- Department of Clinical Pharmacy, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, The Netherlands.
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | - Ilse Houtenbos
- Department of Internal Medicine, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, The Netherlands
| | - Tessa C C Jaspers
- Department of Clinical Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Ankie M Harmsze
- Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Hylke J Kingma
- Pharmacy Foundation of Haarlem Hospitals, Haarlem, The Netherlands
- Department of Clinical Pharmacy, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, The Netherlands
| | - Diego A M Odekerken
- Department of Cardiology, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, The Netherlands
| | - Karina Meijer
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs L Becker
- Pharmacy Foundation of Haarlem Hospitals, Haarlem, The Netherlands
- Department of Clinical Pharmacy, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, The Netherlands
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van Uden RCAE, Houtenbos I, Griffioen-Keijzer A, Odekerken DAM, van den Bemt PMLA, Becker ML. Guidelines for mono, double and triple antithrombotic therapy. Postgrad Med J 2021; 97:730-737. [PMID: 33441477 DOI: 10.1136/postgradmedj-2020-138938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022]
Abstract
Guidelines for antithrombotic therapy are complex, especially if a patient has several indications that require antithrombotic therapy. In general, no patient should receive lifelong double or triple antithrombotic therapy. In this overview, we outline the most common indications for mono, double and triple antithrombotic therapy; the preferred antithrombotic therapy and the recommended duration of therapy. Both antiplatelet therapy and therapeutic anticoagulation therapy with vitamin K antagonists or direct oral anticoagulants were included. European guidelines were used or, if no European guidelines were available, the Dutch guidelines were used.
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Affiliation(s)
- Renate C A E van Uden
- Hospital Pharmacy, Spaarne Gasthuis, Haarlem, Noord-Holland, Netherlands.,Pharmacy Foundation of Haarlem Hospitals, Haarlem, Noord-Holland, Netherlands
| | - Ilse Houtenbos
- Internal Medicine, Spaarne Gasthuis, Haarlem, Noord-Holland, Netherlands
| | | | | | - Patricia M L A van den Bemt
- Clinical Pharmacy and Pharmacology, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
| | - Matthijs L Becker
- Hospital Pharmacy, Spaarne Gasthuis, Haarlem, Noord-Holland, Netherlands .,Pharmacy Foundation of Haarlem Hospitals, Haarlem, Noord-Holland, Netherlands
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Moerlie AR, Uden RCV, Mantel-Teeuwisse AK, Bemt PVD, Becker ML. Inpatient prescribing of dual antiplatelet therapy according to the guidelines: a prospective intervention study. Pharm Pract (Granada) 2020; 18:1803. [PMID: 32587641 PMCID: PMC7308913 DOI: 10.18549/pharmpract.2020.2.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/31/2020] [Indexed: 12/24/2022] Open
Abstract
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 25
th
, 2019, and June 14
th
, 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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Affiliation(s)
- Ashwin R Moerlie
- Pharmacy Foundation of Haarlem Hospitals. Haarlem (The Netherlands).
| | - Renate C Van Uden
- PharmD. Hospital Pharmacist. Pharmacy Foundation of Haarlem Hospitals. Haarlem (The Netherlands).
| | - Aukje K Mantel-Teeuwisse
- PharmD, PhD. Professor of Pharmacy and Global Health. Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University. Utrecht (The Netherlands).
| | - Patricia Van Den Bemt
- PharmD, PhD. Hospital Pharmacist, Professor in Medication Safety. Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen. Groningen (The Netherlands).
| | - Matthijs L Becker
- PharmD, PhD. Hospital Pharmacist, Researcher, Pharmacy Foundation of Haarlem Hospitals. Haarlem (The Netherlands).
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Prochaska JH, Coldewey M, Göbel S, Keller K, Hendelmeier M, Konstantinides S, Münzel T, Wild PS. Evaluation of oral anticoagulation therapy: Rationale and design of the thrombEVAL study programme. Eur J Prev Cardiol 2014; 22:622-8. [DOI: 10.1177/2047487314527852] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 02/20/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Jürgen H Prochaska
- Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
- Department of Medicine 2, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
| | - Meike Coldewey
- Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
- Department of Medicine 2, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
| | - Sebastian Göbel
- Department of Medicine 2, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), University Medical Centre Mainz, Germany
| | - Karsten Keller
- Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
- Department of Medicine 2, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
| | - Martin Hendelmeier
- Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
| | - Stavros Konstantinides
- Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
| | - Thomas Münzel
- Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
- Department of Medicine 2, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), University Medical Centre Mainz, Germany
| | - Philipp S Wild
- Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
- Department of Medicine 2, University Medical Centre Mainz, Johannes Gutenberg University Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), University Medical Centre Mainz, Germany
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