An Intervention to Reduce Antiplatelet Use without Gastroprotection in Patients Using Warfarin: The AEGIS Cluster Randomized Trial.

Kurlander JE, Helminski D, Tao X, Saini SD, Krein SL, Richardson CR, Kidwell KM, Lanham MSM, Henstock JL, Resnick J, Song M, Vries R, Resnicow K, Ha N, Haymart B, Alexandris-Souphis C, Froehlich JB, Barnes GD. An Intervention to Reduce Antiplatelet Use without Gastroprotection in Patients Using Warfarin: The AEGIS Cluster Randomized Trial. Thrombosis and Haemostasis. 2025 May 2 DOI: 10.1055/a-2544-6104.

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Abstract:

Many patients receiving anticoagulants take antiplatelet medications unnecessarily and without gastroprotection, increasing the risk of gastrointestinal bleeding.To evaluate the effectiveness of a multicomponent intervention-clinician notification with nurse facilitation (CNNF)-in reducing high-risk use of antiplatelet medications in patients taking warfarin without a proton pump inhibitor (PPI).For patients in the CNNF group, nurses sent electronic messages to clinicians identifying patients with high-risk antiplatelet use, recommending consideration of either antiplatelet discontinuation or PPI initiation, and offering to facilitate any medication changes. The primary outcome was the percentage of patients who self-reported either discontinuing antiplatelet therapy or initiating a PPI at 7 to 10 weeks. The secondary outcome was the percentage of patients with a documented clinician recommendation to make such a medication change.Among 220 patients, CNNF was associated with increased odds of discontinuing antiplatelet therapy or initiating a PPI in the intention-to-treat analysis (adjusted odds ratio [aOR] 5.76, 95% CI 2.54, 13.05). The effect was stronger in a modified completer analysis ( = 126, aOR 43.6, 95% CI 6.56, 289.88). The intervention was also associated with increased odds of a clinician recommendation for a medication change (75/110 [68.2%] versus 1/110 [0.9%], log aOR 19.86, 95% CI 10.63, 29.09). Surgeons and proceduralists were less likely to recommend medication changes relative to other clinicians (log aOR -16.08, 95% CI -23.34, -8.82).The multicomponent intervention effectively led to antiplatelet discontinuation or PPI initiation in patients initially prescribed warfarin-antiplatelet therapy without gastroprotection.