Impact of an Anticoagulation Management Service-led Intervention on Rates of Antiplatelet and Gastric Bleeding Prophylaxis Use in Ambulatory Care Patients on Background Direct Oral Anticoagulants

Background: Patients on long-term anticoagulation face increased bleeding risk when antiplatelets are co-prescribed, especially upper gastrointestinal (GI) bleeding. Guidelines recommend limiting antiplatelet use to highly select patients on background anticoagulants and promoting GI prophylaxis with proton pump inhibitors (PPIs) for those requiring dual antithrombotic therapy. Objectives: To assess the impact of an anticoagulation management service (AMS)-led intervention on reducing excess antiplatelet use and increasing PPI prescribing in patients who require continued antiplatelet therapy. Methods: This study of retrospective chart review included adults (≥18 years) on long-term direct oral anticoagulant (DOAC) therapy from October 2023 to September 2024. The intervention group included AMS-enrolled patients who received structured annual anticoagulation review. The control group consisted of DOAC patients receiving usual care outside AMS. The AMS annual review aims to optimize antithrombotic therapy by deprescribing unnecessary antiplatelets and initiating PPIs when clinically indicated. Results: Of 8,462 eligible patients, 3,125 were in the AMS group and 5,337 in the non-AMS group. Antiplatelet use was significantly lower in AMS patients at baseline (9% vs. 15%) and study end (7% vs. 16%) (p<0.0001). PPI use was significantly higher in AMS patients at both time points (50% vs. 30% for baseline, 67% vs. 38% at the end of study) (p<0.0001). Acceptance rates for AMS recommendations were 18.8% for antiplatelet discontinuation and 33% for PPI initiation. Conclusion: AMS-led interventions effectively reduced concurrent antiplatelet use in patients on background DOAC and increased PPI prescribing in those on dual therapy, demonstrating the value of centralized anticoagulation services in primary care.