Search
Presentation Details
| Evaluation of a Pharmacist-led Perioperative Antithrombotic Management Service |
| Nghi Ha, Liza Renner, Erin Mouland, Denise Sutter-Long, Anisa Bici Michigan Medicine, Ann Arbor, MI, United States |
Introduction Perioperative management is an important component of antithrombotic stewardship. An appropriate perioperative plan minimizes risk of thrombosis and bleeding around time of procedure. The Perioperative service was initiated in 2013. Expansion in 2015 included all anticoagulated patients undergoing cardiac catheterization, and 2018 to include patients undergoing GI procedures. Methods This is a retrospective review of all perioperative cases referred to a pharmacist-led perioperative management service between 2013-2024. Results This study included 28,470 cases. Referral grew significantly from 51 cases in 2013 to 4,453 cases in 2024. Procedure types include GI (51.2%), cardiac catheterizations (29.5%), and other general surgeries (9.6%). Referrals came from cardiology (45.8%), GI (31.1%), and general medicine (16.1%). Direct oral anticoagulants accounted for 48.8% of cases, followed by warfarin (39.0%), and P2Y12 inhibitors (9.8%). AFib was the most common antithrombotic indication (46%), follow by VTE (33.1%) and CAD (6.6%). Patients included those with low (45.8%), moderate (43.8%) and high thrombotic risk (10.4%). Perioperative bridging occurred in 19.3% of cases, with majority of bridging done in the outpatient setting (97.2%). Rate of bridging decreased significantly over time, with 88% in 2013 to 12.8% in 2024. At the time of pharmacist review, a provider had already proposed a perioperative plan in 4723 cases. Of these, 25% of plans had to be modified by pharmacists. Conclusion Need for perioperative management has grown significantly. Pharmacists can effectively assist with this process, especially in the minimization of unnecessary perioperative bridging. Requirement for bridging has decreased significantly over time. |