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| Evaluation of Antithrombotic Use in Patients Presenting to the Emergency Department with a Gastrointestinal Bleed |
| Tara K. Lech1, Caitlyn Leonard2, Corinne M. Bertolaccini2 1Beth Israel Lahey Health, Westwood, MA, United States/2Lahey Hospital and Medical Center, Burlington, MA, United States |
Introduction As the number of patients on antithrombotic therapy (AT) continues to rise, so does the number of associated adverse events. While many of these events are iatrogenic, an estimated 10-30% are associated with inappropriate prescribing, off label dosing and failure to manage high-risk interactions. The purpose of this study is to identify opportunities for AT stewardship in patients presenting to the emergency department (ED) with gastrointestinal bleeding (GIB). Methods This single center, retrospective study included patients 18 years or older on AT presenting to the ED with a GIB at Lahey Hospital and Medical Center from January 2021 to September 2023. The primary outcome was opportunities for AT stewardship, including inappropriate dose or duration, no clear indication for AT, and identification of high bleed risk interactions. The secondary outcome focused on appropriate use of gastroprotection. Results 70 patients were included with a mean age of 78 years, 35% female, and 54 (77%) were on AT > 6 months prior to presentation. The most common indications for AT use were atrial fibrillation 44 (63%) and venous thromboembolism 15 (21%). AT use included apixaban 36 (51%), rivaroxaban 9 (13%), warfarin 13 (19%), clopidogrel 16 (23%) and aspirin 29 (41%), with some patients prescribed multiple agents. 47 (67%) patients had opportunities for AT stewardship prior to presentation. 17 (24%) had inappropriate doses, with 12/17 (71%) on a higher than recommended dose. 2 patients had inappropriate duration of therapy, 4 had no clear indication for their AT and 10 (14%) were noted to have high bleed risk drug interactions. Additionally, when applying the TUNA 2 criteria (Thienopyridine use, Ulcer History, NSAID, Aspirin or Anticoagulant), we found that 31.4% of patients that qualified for gastroprotection were not prescribed a proton pump inhibitor or an H2 receoptor antagonist. Conclusion AT stewardship programs focused on evidence-based prescribing, monitoring and appropriate follow up may help decrease preventable AT related adverse drug events. |