title: Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol.
abstract: Antithrombotic 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.
  
  
  
  In 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.
  
  
  
  This 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.
  
  
  
  NTR4887; pre-results.
authors.affiliation: Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.|Department of Hospital Pharmacy, Reinier de Graaf Hospital, Delft, The Netherlands.
authors.forename: Albert R
authors.initials: AR
authors.lastname: Dreijer
authors.affiliation: Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Marieke J H A
authors.initials: MJ
authors.lastname: Kruip
authors.affiliation: Department of Hospital Pharmacy, Reinier de Graaf Hospital, Delft, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Diepstraten
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
authors.affiliation: Department of Hematology, Reinier de Graaf Hospital, Delft, The Netherlands.
authors.forename: Rolf
authors.initials: R
authors.lastname: Brouwer
authors.affiliation: Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Frank W G
authors.initials: FW
authors.lastname: Leebeek
authors.affiliation: Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Vulto
authors.affiliation: Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Patricia M L A
authors.initials: PM
authors.lastname: van den Bemt
mesh_terms: D000046:Academic Medical Centers; D000925:Anticoagulants / Q000627:therapeutic use*; D001158:Arteries / Q000473:pathology; D003362:Cost-Benefit Analysis; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000209:etiology; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy; D009426:Netherlands; D010348:Patient Care Team; D011655:Pulmonary Embolism / Q000188:drug therapy; D012107:Research Design; D020521:Stroke; D013927:Thrombosis / Q000188:drug therapy*; D014680:Veins / Q000473:pathology; D020246:Venous Thrombosis / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: EPIDEMIOLOGY