Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review
Magnolia Cardona,
Louise Craig,
Mark Jones,
Oyungerel Byambasuren,
Mila Obucina,
Laetitia Hattingh,
Justin Clark,
Paul Glasziou,
Tammy Hoffmann
Affiliations
Magnolia Cardona
Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD; Evidence Based Practice Professorial Unit, Gold Coast University Hospital, Southport, QLD
Louise Craig
Institute of Cardiovascular and Medical Sciences, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow
Mark Jones
Associate Professor, Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD
Oyungerel Byambasuren
Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD
Mila Obucina
Gold Coast Hospital and Health Service, Southport, QLD
Laetitia Hattingh
Gold Coast Hospital and Health Service, Southport, QLD
Justin Clark
Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD
Paul Glasziou
Professor, Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD
Tammy Hoffmann
Professor, Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD
Thromboembolic events are a common risk in adults with atrial fibrillation, those with previous cerebrovascular accidents and undergoing emergency or elective surgeries. The widespread availability of antithrombotic agents and differing guidelines contribute to practice variations and increased risk of complications and deaths. The objective of this review was to investigate the extent of overuse and underuse of antithrombotics for primary or secondary prevention as measured by deviation from prescribing guideline recommendations. We conducted a systematic review of Medline and EMBASE for quantitative articles published between 2000 and 2021 and used a modified version of the Hoy’s risk of bias assessment tool. Here we report evidence from the past decade about wide practice variations in hospitals and primary care, and discuss clinician and patient-driven determinants of non-adherence to guidelines. Finally, we summarise implications for practice, identify enhanced ways of measuring overuse and underuse, and propose potential solutions to the measurement challenges.
