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Occurrence of Antithrombotic Related Adverse Events in Hospitalized Patients: Incidence and Clinical Context between 2008 and 2016

Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, 1081 BT Amsterdam, The Netherlands
Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, The Netherlands
PinkRoccade healthcare, 7324 AE Apeldoorn, The Netherlands
Department of Thrombosis and Hemostasis, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(6), 839;
Received: 13 May 2019 / Revised: 24 May 2019 / Accepted: 6 June 2019 / Published: 12 June 2019
(This article belongs to the Section Epidemiology & Public Health)
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Antithrombotic drugs are consistently involved in medication-related adverse events (MRAEs) in hospitalized patients. We aimed to estimate the antithrombotic-related adverse event (ARAE) incidence between 2008 and 2016 and analyse their clinical context in hospitalized patients in The Netherlands. A post-hoc analysis of three national studies, aimed at adverse event (AE) identification, was performed. Previously identified AEs were screened for antithrombotic involvement. Crude and multi-level, case-mix adjusted ARAE and MRAE incidences were calculated. Various contextual ARAE characteristics were analysed. ARAE incidence between 2008 and 2016 decreased significantly in in-hospital deceased patients from 1.20% (95% confidence interval (CI): 0.63–2.27%) in 2008 to 0.54% (95% CI: 0.27–1.11%) in 2015/2016 (p = 0.02). In discharged patients ARAE incidence remained stable. By comparison, overall MRAE incidence remained stable for both deceased and discharged patients. Most ARAEs involved Vitamin-K antagonists (VKAs). Preventable ARAEs occurred more during weekends and with increasing multidisciplinary involvement. Antiplatelet and combined antithrombotic use seemed to be increasingly involved in ARAEs over time. ARAE incidence declined by 55% in deceased patients between 2008 and 2016. Opportunities for improving antithrombotic safety should target INR monitoring and care delivery aspects such as multidisciplinary involvement and weekend care. Future ARAE monitoring for the involvement of antiplatelet, combined antithrombotic and direct oral anticoagulant (DOAC) use is recommended. View Full-Text
Keywords: anticoagulants; antithrombotic drugs; epidemiological studies; medication safety anticoagulants; antithrombotic drugs; epidemiological studies; medication safety

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Moesker, M.J.; Schutijser, B.C.; de Groot, J.F.; Langelaan, M.; Spreeuwenberg, P.; Huisman, M.V.; de Bruijne, M.C.; Wagner, C. Occurrence of Antithrombotic Related Adverse Events in Hospitalized Patients: Incidence and Clinical Context between 2008 and 2016. J. Clin. Med. 2019, 8, 839.

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