Douketis JD, Spyropoulos AC, Murad MH, et al. Perioperative management of antithrombotic therapy: an American College of Chest Physicians clinical practice guideline. Chest. 2022;162(5):e207–43. https://doi.org/10.1016/j.chest.2022.07.025.

Article  PubMed  CAS  Google Scholar 

Leendertse AJ, Egberts AC, Stoker LJ, et al. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890–6. https://doi.org/10.1001/archinternmed.2008.3.

Article  PubMed  Google Scholar 

Omling E, Jarnheimer A, Rose J, et al. Population-based incidence rate of inpatient and outpatient surgical procedures in a high-income country. Br J Surg. 2018;105(1):86–95. https://doi.org/10.1002/bjs.10643.

Article  PubMed  CAS  Google Scholar 

Beyer-Westendorf J, Gelbricht V, Förster K, et al. Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J. 2014;35(28):1888–96. https://doi.org/10.1093/eurheartj/eht557.

Article  PubMed  CAS  Google Scholar 

Munk L, van Essen T, van der Hoeven C, et al. Compliance to perioperative anticoagulation protocols in elderly patients undergoing elective orthopedic procedures: a retrospective observational cohort study on 548 patients. Patient Saf Surg. 2023;17(1):9. https://doi.org/10.1186/s13037-023-00357-w.

Article  PubMed  PubMed Central  Google Scholar 

Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826–924. https://doi.org/10.1093/eurheartj/ehac270.

Article  PubMed  Google Scholar 

Kotecha D, Breithardt G, Camm AJ, et al. Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA consensus conference. EP Europace. 2018;20(3):395–407. https://doi.org/10.1093/europace/eux318.

Article  PubMed  Google Scholar 

Anticoagulation Forum. Core elements of anticoagulation stewardship programs. https://acforum.org/web/downloads/ACF%20Anticoagulation%20Stewardship%20Guide.pdf. Accessed 16 Apr 2025.

Tafur AJ, Barnes GD, Bhagirath VC, et al. Anticoagulation stewardship to bridge the implementation gap in perioperative anticoagulation management. TH Open. 2024;8(1):e114–20. https://doi.org/10.1055/a-2259-0911.

Article  PubMed  PubMed Central  Google Scholar 

Dreijer AR, Diepstraten J, Leebeek FWG, et al. The effect of hospital-based antithrombotic stewardship on adherence to anticoagulant guidelines. Int J Clin Pharm. 2019;41(3):691–9. https://doi.org/10.1007/s11096-019-00834-2.

Article  PubMed  PubMed Central  Google Scholar 

Kefale B, Peterson GM, Mirkazemi C, et al. The effect of pharmacist-led interventions on the appropriateness and clinical outcomes of anticoagulant therapy: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2024;10(6):488–506. https://doi.org/10.1093/ehjqcco/qcae045.

Article  PubMed  PubMed Central  Google Scholar 

Falamić S, Lucijanić M, Ortner-Hadžiabdić M, et al. Pharmacists’ influence on adverse reactions to warfarin: a randomised controlled trial in elderly rural patients. Int J Clin Pharm. 2019;41(5):1166–73. https://doi.org/10.1007/s11096-019-00894-4.

Article  PubMed  CAS  Google Scholar 

Beyene K, Chan AHY, Barton E, et al. Pharmacists views on participating in New Zealand’s community pharmacy anticoagulation management service: a mixed-methods study. Int J Clin Pharm. 2021;43(1):251–62. https://doi.org/10.1007/s11096-020-01148-4.

Article  PubMed  Google Scholar 

Ritchie LA, Penson PE, Akpan A, et al. Integrated care for atrial fibrillation management: the role of the pharmacist. Am J Med. 2022;135(12):1410–26. https://doi.org/10.1016/j.amjmed.2022.07.014.

Article  PubMed  Google Scholar 

Desmaele S, De Wulf I, Dupont AG, et al. Pharmacists’ role in handling problems with prescriptions for antithrombotic medication in Belgian community pharmacies. Int J Clin Pharm. 2015;37(4):656–68. https://doi.org/10.1007/s11096-015-0106-3.

Article  PubMed  CAS  Google Scholar 

Moudallel S, Cornu P, Dupont A, et al. Determinants for under- and overdosing of direct oral anticoagulants and physicians’ implementation of clinical pharmacists’ recommendations. Br J Clin Pharmacol. 2022;88(2):753–63. https://doi.org/10.1111/bcp.15017.

Article  PubMed  CAS  Google Scholar 

Perlman A, Horwitz E, Hirsh-Raccah B, et al. Clinical pharmacist led hospital-wide direct oral anticoagulant stewardship program. Isr J Health Policy Res. 2019;8(1):19. https://doi.org/10.1186/s13584-019-0285-9.

Article  PubMed  PubMed Central  Google Scholar 

van Paassen JG, Tan JP, Deneer VHM, et al. Exploring the pharmacists’ role in optimising antithrombotic therapy in primary care: a qualitative study. BMJ Open. 2024;14(3): e079018. https://doi.org/10.1136/bmjopen-2023-079018.

Article  PubMed  PubMed Central  Google Scholar 

Atkins L, Francis J, Islam R, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77. https://doi.org/10.1186/s13012-017-0605-9.

Article  PubMed  PubMed Central  Google Scholar 

Francis JJ, Johnston M, Robertson C, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229–45. https://doi.org/10.1080/08870440903194015.

Article  PubMed  Google Scholar 

Shang J, Ning W, Gong J, et al. Impact of clinical pharmacist services on anticoagulation management of total joint arthroplasty: a retrospective observational study. J Clin Pharm Ther. 2021;46(5):1301–7. https://doi.org/10.1111/jcpt.13428.

Article  PubMed  Google Scholar 

Hyland SJ, Kramer BJ, Fada RA, et al. Clinical pharmacist service associated with improved outcomes and cost savings in total joint arthroplasty. J Arthroplasty. 2020;35(9):2307-2317.e1. https://doi.org/10.1016/j.arth.2020.04.022.

Article  PubMed  Google Scholar 

Dreijer AR, Kruip M, Diepstraten J, et al. Effect of antithrombotic stewardship on the efficacy and safety of antithrombotic therapy during and after hospitalization. PLoS ONE. 2020;15(6): e0235048. https://doi.org/10.1371/journal.pone.0235048.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Papastergiou J, Kheir N, Ladova K, et al. Pharmacists’ confidence when providing pharmaceutical care on anticoagulants, a multinational survey. Int J Clin Pharm. 2017;39(6):1282–90. https://doi.org/10.1007/s11096-017-0551-2.

Article  PubMed  PubMed Central  Google Scholar 

Capiau A, Mehuys E, Dhondt E, et al. Physicians’ and pharmacists’ views and experiences regarding use of direct oral anticoagulants in clinical practice. Br J Clin Pharmacol. 2022;88(4):1856–65. https://doi.org/10.1111/bcp.15106.

Article  PubMed  Google Scholar 

Saeed H, Ovalle OG, Bokhary U, et al. National physician survey for Nonvalvular Atrial Fibrillation (NVAF) anticoagulation comparing knowledge, attitudes and practice of cardiologist to PCPs. Clin Appl Thromb Hemost. 2020;26: 1076029620952550. https://doi.org/10.1177/1076029620952550.

Article  PubMed  PubMed Central  Google Scholar 

Mertens JF, Koster ES, Deneer VHM, et al. Factors influencing pharmacists’ clinical decision making in pharmacy practice. Res Social Adm Pharm. 2023;19(9):1267–77. https://doi.org/10.1016/j.sapharm.2023.05.009.

Article  PubMed  CAS  Google Scholar 

Capiau A, De Vleeschauwer J, De Backer T, et al. Optimizing anticoagulation therapy for in-hospital patients on direct oral anticoagulants: a single-centre modified Delphi study. Br J Clin Pharmacol. 2024. https://doi.org/10.1111/bcp.16159.

Article  PubMed  Google Scholar 

Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41. https://doi.org/10.1001/jama.297.8.831.

Article  PubMed  CAS  Google Scholar