Presentation Details
| Antithrombosis Stewardship as a Key Driver within a VTE Center of Excellence - AMBITION Investigators  Angela M.Martoccia Grabazs, Preeyaporn Sarangarm, Sundeep S.Guliani, Jonathan L.Marinaro, Allison E.Burnett. University of New Mexico Hospital, Albuquerque, NM, USA |
Abstract
Background Pulmonary embolism (PE) and deep vein thrombosis (DVT), collectively known as venous thromboembolism (VTE), account for >250,000 hospitalizations in the United States annually. Patients with VTE have an increased risk of recurrent thromboembolism or death within the first 4 weeks of the index event, and thus require comprehensive initial anticoagulation management in addition to a well-defined plan for care transitions. Additionally, risk stratification is important in directing acute VTE management, such as initial anticoagulation and treatment setting (inpatient versus outpatient). The 2019 ESC guidelines for the diagnosis and management of acute PE as well as the 2021 update to 2012 CHEST guidelines for antithrombotic therapy in VTE recommend prompt initiation of parenteral anticoagulation to improve patient outcomes, with preference for low molecular weight heparin (LMWH) or fondaparinux over unfractionated heparin (UFH). Initial use of these agents has been associated with significant reduction in recurrent VTE, major bleeding and a trend toward lower mortality. Pharmacists are uniquely equipped to aid in optimization of VTE management, including initial and longer-term anticoagulation practices, as well as safe and effective transitions of care. In March 2023, our anticoagulation stewardship team partnered with the hospital’s pulmonary embolism response team (PERT), emergency medicine services, urgent care clinic and imaging departments (radiology and vascular lab) to pilot a VTE Center of Excellence. In this pilot, real-time alerts for acute DVT and/or PE are sent via internal messaging to the multidisciplinary team for rapid initial risk stratification and initiation of preferred, evidence-based anticoagulation. Objectives This pre-post research is designed to assess the impact of pharmacy-driven anticoagulation stewardship on acute and longer-term antithrombotic management and care transitions for high-risk VTE. Methods Retrospective analysis of pre-post intervention will include all adult patients who present to defined care areas between January 2021 and September 2023 with high-risk VTE within service hours (Monday-Friday 0700-1730). Patients will be excluded if anticoagulation is started at an outside hospital or during UNMH admission for alternate primary diagnosis, if they are discharged from care locations without admission, and if they are pregnant or incarcerated. The primary outcome is time to first dose of parenteral anticoagulant following acute VTE diagnosis. Secondary outcomes include choice of first anticoagulant, hospital length of stay, mortality rate in hospital and within 30 days of VTE diagnosis, and rate of completion of a transitions of care (TOC) “bundle”. Transitions of care services include provision of outpatient medication supply and patent/caregiver education at discharge, as well as placement of an outpatient anticoagulation referral. Time to follow up call and confirmation of maintenance anticoagulant coverage will also be assessed within the TOC bundle. Results Data collection and analysis is currently ongoing. Conclusions This research is designed to inform the impact of real time pharmacy-driven antithrombosis stewardship involvement on patient outcomes when completed as a component of a multidisciplinary pilot VTE Centers of Excellence program.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.