Impact of a Pharmacist-led Anticoagulation Model Based on Early Active Consultation in Orthopedic Surgery: A Retrospective Cohort Study

Introduction Venous thromboembolism (VTE) is a common and preventable complication in orthopedic surgery, yet adherence to prophylaxis guidelines remains suboptimal. A pharmacist-led anticoagulation care model based on the Pharmacist Early Active Consultation (PEAC) framework may enhance the quality and safety of VTE prevention in surgical patients. Aim This study aimed to evaluate the impact of a pharmacist-led Venous Thromboembolism Clinical Pharmaceutical Care (VTE-CPC) model, derived from the PEAC framework, on VTE prevention and anticoagulation quality in orthopedic surgery patients. Method A retrospective cohort study was conducted at a tertiary hospital in China. Patients admitted between December 2023 and May 2024 received routine care (no VTE-CPC group), while those admitted between June and November 2024 received additional pharmacist-led interventions (VTE-CPC group). Multivariate logistic regression was used to identify independent risk factors for VTE. Propensity score matching (PSM) was performed to control baseline differences, resulting in a balanced cohort of 812 patients. Outcomes included VTE incidence, pharmacological prophylaxis practices, and safety endpoints. Results A total of 959 patients were included (no VTE-CPC: n = 531; VTE-CPC: n = 428). The incidence of VTE was significantly lower in the VTE-CPC group (3.74%) compared to the no VTE-CPC group (7.53%, p = 0.020). VTE-CPC remained an independent protective factor in multivariate analysis (OR = 0.45; 95% CI: 0.23–0.84; p = 0.015). In the PSM matched cohort, patients in the VTE-CPC group had higher rates of postoperative pharmacological prophylaxis (22.66% vs. 16.26%, p = 0.027) and improved dosage appropriateness across all perioperative phases (p < 0.05). No significant differences were observed between groups in rates of bleeding events, thrombocytopenia, or hepatic/renal dysfunction. Conclusion A pharmacist-led anticoagulation management model based on the PEAC framework significantly reduced perioperative VTE incidence without increasing adverse events. These findings support broader implementation of proactive, pharmacist-driven strategies to improve thromboprophylaxis quality in orthopedic surgery.