PB0029 - Safe Timely resumption of Pharmacologic thromboembolism prevention in Hospitalized patients with A Recent Major Bleed

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Harsh Sharma, DO

Resident Doctor
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States

Co-Author(s)

AB

Allison Burnett

Pharmacist
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
OP

Oksana Petrechko

Resident Doctor
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
BJ

Bradley Jackson

Resident Doctor
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
NK

Natasha Khan

Resident Doctor
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
MM

Mindy Mason

Nurse Practitioner
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
RG

Rachel Garcia

Pharmacist
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
CB

Christopher Bartlett

Attending Physician and Assistant Professor
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States
JZ

Jessica Zimmerberg-Helms

Attending Physician and Assistant Professor
University of New Mexico Health Sciences Center
Albuquerque, New Mexico, United States

Background: Currently, there are no standardized guidelines for the safe resumption of chronic oral anticoagulation (OAC), or consideration of alternative means to thromboembolism prevention, following spontaneous or traumatic intracerebral hemorrhage (ICH). This is exacerbated by differing or nonexistent resumption protocols between hospitals and can lead to potential adverse events.

Aims: Our needs assessment, utilizing the Plan-Do-Study-Act (PDSA) cycle, will identify deficits in post-ICH management and opportunities to facilitate anticoagulation stewardship and improve patient management across the continuum of care.

Methods: A secured database was used to collect, de-identify, and store retrospective data on 103 patients admitted for ICH over a six-month period. 32 patients were taking OAC at the time of admission, and their charts were reviewed to evaluate common clinical characteristics and management practices such as time to initiation of venous thromboembolism prophylaxis and documentation of plan for OAC resumption, including timing and choice of OAC (table 1).

Results: 12 patients (37.5%) did not survive hospital admission. Among these fatal cases, ICH was attributed as the primary cause of death in 9 individuals, and 3 deaths were secondary to acquired infection after hemorrhagic stabilization. Of the 20 surviving patients (62.5%), only 9 (45%) had a documented resumption plan in their discharge summary (figure 1). Five resumed anticoagulation during admission, 3 were referred for left atrial appendage occlusion (LAAO), 2 had no resumption plan or alternative prevention documented at discharge, and 1 had OAC discontinued due to inappropriate prescription. Six (30%) patients did not have follow up scheduled with a neurologist or neurosurgeon.

Conclusion(s): Given the variability in practice seen at our institution, we believe the development of a standardized multidisciplinary post-ICH protocol is needed. Electronic medical record (EMR)-based workflow checkpoints and stepwise guidelines will equip clinicians with additional tools to decrease the likelihood of adverse events.