Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

Research and Practice in Thrombosis and Haemostasis

Abstract

Background : From 2017 – 2018, the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) implemented a multicenter quality improvement project to reduce excess aspirin use among patients on warfarin. Analysis 24 months post-intervention showed significant reductions in aspirin use and the intervention was associated with improved bleeding outcomes. It was unclear if these outcomes would be sustained. Aims : To evaluate pre- and post- intervention aspirin use, bleeding, and thrombotic outcomes, now with up to 84 months of follow-up data. Methods : Included patients were adults on long-term warfarin for atrial fibrillation and/or venous thromboembolism without an apparent indication for aspirin. We analyzed monthly event rates of any bleeding, major bleeding, non-major bleeding, and thrombosis using registry data from January 2010 through December 2024. We conducted interrupted time series analyses utilizing linear regression models and compared pre-/post-intervention mean monthly event rates. Results : A total of 8,187 patients met the inclusion criteria and were followed for an average of 23 months. Monthly aspirin use without an indication declined from an average of 27% pre-intervention to 11.4% post-intervention (p < 0.001), with a sustained decline up to 84 months post-intervention (Figure 1). Post-intervention, significantly lower average monthly rates of any bleeding (1.5% vs. 2.2%, p < 0.001), major bleeding (0.2% vs. 0.3%, p < 0.001), and non-major bleeding events (1.3% vs 1.9%, p < 0.001) were observed. However, bleeding event rates trended significantly upwards over time (Figure 2). There was no significant difference in monthly thrombotic event rates. Conclusion(s) : Our antithrombotic stewardship intervention was associated with a significant decline in aspirin use. While bleeding declined, it did not follow the same trend as aspirin use making it less likely that this was due to the intervention. Further study of patient-level data with adjustment for bleeding risk is necessary to determine if declines in aspirin use improve bleeding outcomes.

Volume

9

Issue

Suppl 2

First Page

124

Last Page

125

Comments

2025 Congress of the International Society of Thrombosis and Haemostasis, June 21-25, 2025, Washington, DC

DOI

10.1016/j.rpth.2025.102923

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