Optimalisatie van protocoladherentie bij postoperatieve antistollingszorg; evaluatie van interventies door apothekersassistenten

Abstract

ABSTRACT

Background Currently, surgery in patients with antithrombotic therapy frequently results in complications, such as thromboembolisms or bleedings. Interruptions around the time of surgery adds more complexity and require extra monitoring by a process called ‘’perioperative anticoagulant management’’ (PAM). Optimal practice of PAM guidelines minimalizes the amount of incidents related to anticoagulation use. The aim of is this study is to evaluate the effect of active monitoring of postoperative anticoagulation therapy on the PAM guideline adherence by pharmacy practitioners. Additionally, the availability of postoperative instructions regarding anticoagulation therapy have been studied.

Method This is a non-controlled, non-randomized intervention study divided into two parts. Included patients required the use of a vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC) before elective surgery. Prior to the intervention, a retrospective study had been performed from January 2019 until December 2019 to collect data about the PAM protocol adherence. The intervention consisted of actively monitoring patients from October 2021 until January 2023 to establish optimal PAM compliant care.

Results Pre-intervention, in 120 patients, an adherence of 15.8% to 89.2% had been observed, depending on the PAM protocol step. Actively monitoring 120 patients in the post-intervention phase emerged in an adherence between 25.0% and 97.4%. Improvement of PAM compliant care had significantly occurred in several steps; starting thrombosis prophylaxis in the right dose and at the correct moment, starting bridging with low-molecular-weight heparines (LMWH) in the accurate dose and discontinue bridging with LMWH when the international normalized rate (INR) had reached the target value. Secondary, only 19.6% of the study files contained postoperative instructions regarding anticoagulants.

Conclusion This study showed inadequate use of PAM protocol guidelines and suboptimal adherence. Active monitoring of the PAM guideline adherence by pharmacy practitioners significantly improved the adherence for several PAM steps.