Maria Macoviciuc , Christina Furneri , Léa Callens , Bao Ling Wei , Helen Mantzanis , Nikki Kampouris , Maral Koolian , Vincent Dagenais-Beaulé , Ryan S. Kerzner
{"title":"长期护理和康复的门诊环境中的抗凝管理-一项多中心描述性试点研究。","authors":"Maria Macoviciuc , Christina Furneri , Léa Callens , Bao Ling Wei , Helen Mantzanis , Nikki Kampouris , Maral Koolian , Vincent Dagenais-Beaulé , Ryan S. Kerzner","doi":"10.1016/j.thromres.2024.109238","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Anticoagulants have consistently emerged as the leading cause of adverse drug events in both inpatient and outpatient settings. While literature on anticoagulation stewardship programs (ACSP) exists for hospital settings, there is a paucity of data in long-term care and rehabilitation settings.</div></div><div><h3>Objective</h3><div>Assess the feasibility of a pharmacist led ACSP in the ambulatory healthcare settings of long-term care facilities (LTC) and rehabilitation centers (RC).</div></div><div><h3>Methods</h3><div>We conducted a prospective pilot project in 3 rehabilitation centers and 7 long-term care facilities. Patients were selected over 5 months in 2023. Patient and anticoagulant prescription-related characteristics were collected. The primary feasibility outcome was the proportion of anticoagulant prescription reviews leading to a pharmacist intervention.</div></div><div><h3>Results</h3><div>A total of 411 patients were enrolled. Common indications for anticoagulants were atrial fibrillation (<em>n</em> = 255, 62.0 %), medical thromboprophylaxis (<em>n</em> = 52, 12.7 %) and venous thromboembolism (<em>n</em> = 53, 12.9 %). Direct oral anticoagulants (DOAC) were most frequently prescribed (<em>n</em> = 309, 75.2 %). Of 411 prescription reviews, 93 led to at least one intervention (22.6 %), for a total of 100 interventions. Interventions mainly concerned laboratory ordering (<em>n</em> = 29) and DOAC dose adjustment (<em>n</em> = 24). Baseline anticoagulant characteristics and outcomes varied by healthcare setting.</div></div><div><h3>Conclusion</h3><div>Expanding ACSP into outpatient LTC and RC settings is feasible. ACSP should include both therapeutic and thromboprophylactic anticoagulants. Additional research is warranted to evaluate the viability of ongoing ACSP monitoring, and more extensive prospective studies are required to assess clinical outcomes effectively.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"245 ","pages":"Article 109238"},"PeriodicalIF":3.7000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anticoagulation stewardship in the ambulatory settings of long-term care and rehabilitation - A multi-centric descriptive pilot study\",\"authors\":\"Maria Macoviciuc , Christina Furneri , Léa Callens , Bao Ling Wei , Helen Mantzanis , Nikki Kampouris , Maral Koolian , Vincent Dagenais-Beaulé , Ryan S. Kerzner\",\"doi\":\"10.1016/j.thromres.2024.109238\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Anticoagulants have consistently emerged as the leading cause of adverse drug events in both inpatient and outpatient settings. While literature on anticoagulation stewardship programs (ACSP) exists for hospital settings, there is a paucity of data in long-term care and rehabilitation settings.</div></div><div><h3>Objective</h3><div>Assess the feasibility of a pharmacist led ACSP in the ambulatory healthcare settings of long-term care facilities (LTC) and rehabilitation centers (RC).</div></div><div><h3>Methods</h3><div>We conducted a prospective pilot project in 3 rehabilitation centers and 7 long-term care facilities. Patients were selected over 5 months in 2023. Patient and anticoagulant prescription-related characteristics were collected. The primary feasibility outcome was the proportion of anticoagulant prescription reviews leading to a pharmacist intervention.</div></div><div><h3>Results</h3><div>A total of 411 patients were enrolled. Common indications for anticoagulants were atrial fibrillation (<em>n</em> = 255, 62.0 %), medical thromboprophylaxis (<em>n</em> = 52, 12.7 %) and venous thromboembolism (<em>n</em> = 53, 12.9 %). Direct oral anticoagulants (DOAC) were most frequently prescribed (<em>n</em> = 309, 75.2 %). Of 411 prescription reviews, 93 led to at least one intervention (22.6 %), for a total of 100 interventions. Interventions mainly concerned laboratory ordering (<em>n</em> = 29) and DOAC dose adjustment (<em>n</em> = 24). Baseline anticoagulant characteristics and outcomes varied by healthcare setting.</div></div><div><h3>Conclusion</h3><div>Expanding ACSP into outpatient LTC and RC settings is feasible. ACSP should include both therapeutic and thromboprophylactic anticoagulants. Additional research is warranted to evaluate the viability of ongoing ACSP monitoring, and more extensive prospective studies are required to assess clinical outcomes effectively.</div></div>\",\"PeriodicalId\":23064,\"journal\":{\"name\":\"Thrombosis research\",\"volume\":\"245 \",\"pages\":\"Article 109238\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Thrombosis research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0049384824003700\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Thrombosis research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0049384824003700","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Anticoagulation stewardship in the ambulatory settings of long-term care and rehabilitation - A multi-centric descriptive pilot study
Background
Anticoagulants have consistently emerged as the leading cause of adverse drug events in both inpatient and outpatient settings. While literature on anticoagulation stewardship programs (ACSP) exists for hospital settings, there is a paucity of data in long-term care and rehabilitation settings.
Objective
Assess the feasibility of a pharmacist led ACSP in the ambulatory healthcare settings of long-term care facilities (LTC) and rehabilitation centers (RC).
Methods
We conducted a prospective pilot project in 3 rehabilitation centers and 7 long-term care facilities. Patients were selected over 5 months in 2023. Patient and anticoagulant prescription-related characteristics were collected. The primary feasibility outcome was the proportion of anticoagulant prescription reviews leading to a pharmacist intervention.
Results
A total of 411 patients were enrolled. Common indications for anticoagulants were atrial fibrillation (n = 255, 62.0 %), medical thromboprophylaxis (n = 52, 12.7 %) and venous thromboembolism (n = 53, 12.9 %). Direct oral anticoagulants (DOAC) were most frequently prescribed (n = 309, 75.2 %). Of 411 prescription reviews, 93 led to at least one intervention (22.6 %), for a total of 100 interventions. Interventions mainly concerned laboratory ordering (n = 29) and DOAC dose adjustment (n = 24). Baseline anticoagulant characteristics and outcomes varied by healthcare setting.
Conclusion
Expanding ACSP into outpatient LTC and RC settings is feasible. ACSP should include both therapeutic and thromboprophylactic anticoagulants. Additional research is warranted to evaluate the viability of ongoing ACSP monitoring, and more extensive prospective studies are required to assess clinical outcomes effectively.
期刊介绍：
Thrombosis Research is an international journal dedicated to the swift dissemination of new information on thrombosis, hemostasis, and vascular biology, aimed at advancing both science and clinical care. The journal publishes peer-reviewed original research, reviews, editorials, opinions, and critiques, covering both basic and clinical studies. Priority is given to research that promises novel approaches in the diagnosis, therapy, prognosis, and prevention of thrombotic and hemorrhagic diseases.
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