Thank you for attending THSNA 2026. The virtual meeting is now closed.
| The Clinical Pharmacist: Implementation of Antithrombosis Stewardship in Perioperative Setting Tara Lech. |
Abstract
Background:
Periprocedural management of antithrombotic therapy represents a high-risk transition of care and a critical opportunity for anticoagulation stewardship. Variability in anticoagulant interruption, bridging decisions, and resumption timing contributes to preventable bleeding, thromboembolism, and procedural delays. Guidelines emphasize standardized, risk-based, patient-centered approaches to optimize safety across care transitions. We describe the development and implementation of a pharmacist-led periprocedural antithrombotic stewardship initiative within an anticoagulation clinic using a Plan Do Study Act (PDSA) framework.
Methods:
A baseline needs assessment included retrospective review of direct oral anticoagulant (DOAC) management across procedural services and a structured provider survey evaluating perioperative practices, guideline familiarity, and perceived need for standardized pathways. Process gaps included variable DOAC hold intervals, inconsistent documentation of perioperative plans, and heterogeneity in bridging strategies. Gastrointestinal (GI) procedures, representing a high-volume and elevated bleeding-risk cohort, were selected for pilot implementation. During the Plan phase, we defined measurable aims, established interdisciplinary governance, and developed standardized EHR integrated documentation templates and risk stratified hold/restart algorithms. The Do phase launched a GI-focused pilot incorporating pharmacist-led risk assessment, standardized communication workflows, and patient education. Process, outcome, and balancing measures were collected during the Study phase, with iterative refinements during the Act phase.
Results:
Baseline analysis demonstrated substantial variability in perioperative DOAC management and documentation practices across specialties. Following pilot implementation, adherence to standardized documentation and evidence-informed hold/restart timing improved within the GI cohort. The structured pathway enhanced interdisciplinary coordination and clarified bridging criteria for high-thrombotic-risk patients. Early outcome monitoring showed decreased bleeding and thrombotic event rates without increased procedural delays. Stakeholder feedback supported feasibility and scalability.
Conclusions:
Operationalizing antithrombotic stewardship through a PDSA framework enabled systematic identification of practice variation and implementation of a standardized, pharmacist-led periprocedural management pathway. A GI-focused pilot provided a scalable model for expanding stewardship across procedural services. This initiative demonstrates how anticoagulation stewardship principles can be embedded into periprocedural care to improve safety and reliability across transitions.
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.