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Safety of antithrombotic care in Dutch hospitals.

Moesker, M.J. Safety of antithrombotic care in Dutch hospitals. Utrecht/Amsterdam: Nivel, VU Medical Center, 2023. 158 p. Proefschrift van de Vrije Universiteit.
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Antithrombotic drugs belong to the most used medications in healthcare. About one in ten Dutch inhabitants uses antithrombotic drug. Antithrombotic drugs are used to reduce the risk of clot formation caused by pathologies such as atrial fibrillation or venous thromboembolism. Mitigating this risk comes at the cost of a small increase in the risk of bleeding. Often this trade-off is clear-cut and favours the use of antithrombotic drugs. However, a lot of factors influencing this trade-off can quickly increase the complexity of this trade-off making it less clear-cut. If this is not recognized, this can in some cases result in the occurrence of adverse events related to antithrombotic drug use (ARAEs).

ARAEs gained increasing attention in adverse event studies in the Netherlands in the past two decades but the exact magnitude of this problem remained unknown. Hence, ARAEs were not targeted specifically in national patient safety improvement strategies. This thesis aims to systematically measure the safety of antithrombotic care provided in Dutch hospitals to guide future improvement efforts.

The safety measurement and monitoring framework was used as a guiding framework for the studies in this thesis.7 Research questions were formulated in analogy with the first three dimensions of this framework, i.e.: Past Harm, Reliability and Sensitivity to Operations. In the general discussion the study findings fed the prospective assessment of the last two dimensions of the framework: Anticipation and preparedness and Integration and Learning.

The research questions were:
1) How common are (preventable) antithrombotic related adverse events in Dutch hospitals and what are the circumstances in which they occur?
2) How reliable is perioperative antithrombotic management and administering VTE prophylaxis in Dutch hospitals?
3) How is perioperative antithrombotic management conducted in everyday practice (work-as-done) and how does this relate to predefined procedures (work-as-imagined)?