Announcement
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Development and Implementation of a Screening Tool to Reduce Bleed Risk Associated with Antiplatelet Use in Anticoagulation Clinic Patients Matthew J.DeSchepper, Jennifer Hardman, Megan Gallagher, Hannah Breidenbach, Michelle Te Ronde. Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA |
Abstract
Background: Combination therapy, the concomitant use of oral anticoagulant (OAC) and antiplatelet (AP) therapies, is common in patients with complex cardiovascular disease or following percutaneous coronary intervention. While appropriate in select clinical contexts, prolonged use of combination therapy increases the risk of major bleeding, particularly gastrointestinal (GI) bleeding, without providing additional cardiovascular benefit. The 2025 American College of Cardiology Guidelines for Acute Coronary Syndromes recommend proton pump inhibitor (PPI) co-therapy or aspirin deprescribing in patients receiving OAC, and favor OAC plus a P2Y12 inhibitor over OAC plus aspirin when combination therapy is required. Anticoagulation Clinic pharmacists are uniquely positioned to identify patients who may benefit from antiplatelet de-escalation or initiation of GI prophylaxis. At Froedtert & the Medical College of Wisconsin (F&MCW), pharmacists identify combination therapy patients through manual review, notifying prescribers on a case-by-case basis. This project aims to create a screening tool to identify patients who may be candidates for AP de-escalation or addition of GI prophylaxis, and implement that tool into Anticoagulation Clinic workflows. Primary Objective: To develop and implement a screening tool to allow for identification of patients who would benefit from optimization of AP therapy or GI bleed prophylaxis. Methods: Literature review was performed to develop criteria for AP de-escalation or GI bleed prophylaxis prescription for patients taking combination therapy, including triple antithrombotic therapy. A report was run on active Anticoagulation Clinic patients to identify patients taking combination therapy, then filtered to remove those already on GI prophylaxis such as a PPI or histamine-2 receptor antagonist (H2RA). The remaining patients were then split into two different groups: warfarin patients and direct oral anticoagulant (DOAC) patients. Fifty patients from each group will be randomly selected for manual chart review to determine the recommended intervention: de-escalation of AP therapy or addition of GI prophylaxis if combination therapy is clinically indicated. The Principal Investigator will contact each patient’s managing provider to request the recommended intervention, document each decision, and report overall recommendation acceptance rates following the implementation of the screening tool. Results: The electronic medical record report identified 465 of 3,074 warfarin patients (15.1%) and 109 of 2,265 (4.8%) DOAC patients taking combination therapy without GI prophylaxis. This pilot screening program will include a random sample of 50 warfarin and 50 DOAC patients. Anticipated Impact: This project aims to decrease risk of bleeding events for Anticoagulation Clinic patients at F&MCW by decreasing the percentage of Anticoagulation Clinic patients taking combination therapy, or by increasing rates of medication prescription for GI bleed prophylaxis. Final project outcomes will be presented at the Wisconsin Pharmacy Residency Conference in Madison, WI, scheduled for April 21–22, 2026.
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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.