A major health system tested one multilevel approach to antithrombotic stewardship in the face of antiplatelet overprescribing among DOAC users.Antiplatelet use dropped following an initial educational outreach and a subsequent clinical pharmacist-facing electronic flag within a DOAC population management tool.The greatest benefit was observed in patients with stable CAD, a group appropriate for antiplatelet deimplementation.
The country's largest integrated health system found a way to clamp down on unnecessary antiplatelet use among patients on direct oral anticoagulants (DOACs).
In a quality improvement study, seven health systems within the Veterans Health Administration (VHA; Florida, Georgia, Puerto Rico, and the U.S. Virgin Islands) were subject to a multi-prong intervention comprising clinician education and an electronic, clinical flagging of antiplatelet use without burdening doctors.
Together, the two changes were associated with antiplatelet prescribing going down from 26.1% at baseline to 17.9% across these seven systems 25 months later. This was a significantly better reduction than the drop from 30.1% to 21.6% across control sites (difference of -0.58 percentage points per 6 months), according to a group led by Jacob Kurlander, MD, MS, of VA Ann Arbor Healthcare System in Michigan.
