Anticoagulation stewardship: Improving adherence to clinical guidelines and reducing overuse of venous thromboembolism prophylaxis in hospitalized medical patients

Anticoagulation stewardship: Improving adherence to clinical guidelines and reducing overuse of venous thromboembolism prophylaxis in hospitalized medical patients

Tony Wan a), Stephanie J. Garland b) c), Chipman Taylor Drury a), Justin Lambert d), Joshua Yoon e), Melissa Chan e)

a) Division of General Internal Medicine, Department of Medicine, University of British Columbia, Canada

b) Department of Pharmacy, St. Paul’s Hospital, Vancouver, Canada

c) Faculty of Pharmaceutical Sciences, University of British Columbia, Canada

d) General Internal Medicine Fellowship Program, Department of Medicine, University of British Columbia, Canada

e) Doctors of Medicine Undergraduate Program, Department of Medicine, University of British Columbia, Canada

Abstract

Adherence to guideline recommendations for venous thromboembolism prophylaxis (VTE) in hospitalized medical patients is suboptimal despite national policies and institutional interventions. The aim of this quality improvement project was to improve adherence to guidelines and decrease the overuse of VTE prophylaxis in order to reduce the institutional cost for heparins. A multidisciplinary anticoagulation stewardship program (ACSP) using the audit and feedback strategy was implemented on the medicine inpatient units at a teaching hospital in Canada. The primary outcome measure was a comparison, pre and post introduction of the ACSP, of the costs per 6-month period for prophylactic dose enoxaparin and unfractionated heparin on the medicine units. The balancing measures were the 90-day VTE rate and major bleeding rate during the hospitalization. Six months after the implementation of the ACSP, the cost was decreased by >50 % without any observed negative impact on patient safety. This study demonstrates the potential for anticoagulation stewardship programs to optimize the use of VTE prophylaxis and reduce the associated costs and risks.