{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T02:44:46Z","timestamp":1782182686981,"version":"3.54.5"},"reference-count":23,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Many patients receiving anticoagulants take antiplatelet medications unnecessarily and without gastroprotection, increasing the risk of gastrointestinal bleeding.<\/jats:p><jats:p>To evaluate the effectiveness of a multicomponent intervention\u2014clinician notification with nurse facilitation (CNNF)\u2014in reducing high-risk use of antiplatelet medications in patients taking warfarin without a proton pump inhibitor (PPI).<\/jats:p><jats:p>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.<\/jats:p><jats:p>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 (n\u2009=\u2009126, 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 \u221216.08, 95% CI \u221223.34, \u22128.82).<\/jats:p><jats:p>The multicomponent intervention effectively led to antiplatelet discontinuation or PPI initiation in patients initially prescribed warfarin-antiplatelet therapy without gastroprotection.<\/jats:p>","DOI":"10.1055\/a-2544-6104","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T18:49:58Z","timestamp":1746211798000},"page":"733-743","source":"Crossref","is-referenced-by-count":3,"title":["An Intervention to Reduce Antiplatelet Use without Gastroprotection in Patients Using Warfarin: The AEGIS Cluster Randomized Trial"],"prefix":"10.1055","volume":"125","author":[{"given":"Jacob E.","family":"Kurlander","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Veterans Affairs (VA) Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Helminski","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueting","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer D.","family":"Saini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Veterans Affairs (VA) Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Krein","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Veterans Affairs (VA) Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline R.","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Brown University, Providence, Rhode Island, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelley M.","family":"Kidwell","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.M.","family":"Lanham","sequence":"additional","affiliation":[{"name":"Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"University of Michigan Office of Clinical Informatics, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Henstock","sequence":"additional","affiliation":[{"name":"Health Information Technology and Services, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Resnick","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond De","family":"Vries","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Resnicow","sequence":"additional","affiliation":[{"name":"Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, United States"},{"name":"University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nghi","family":"Ha","sequence":"additional","affiliation":[{"name":"Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Haymart","sequence":"additional","affiliation":[{"name":"Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantina","family":"Alexandris-Souphis","sequence":"additional","affiliation":[{"name":"Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James B.","family":"Froehlich","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6532-8440","authenticated-orcid":false,"given":"Geoffrey D.","family":"Barnes","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States"},{"name":"Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"k2505","DOI":"10.1136\/bmj.k2505","article-title":"Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care","volume":"362","author":"Y Vinogradova","year":"2018","journal-title":"BMJ"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1161\/CIRCULATIONAHA.110.973008","article-title":"Risk of upper gastrointestinal bleeding with low-dose acetylsalicylic acid alone and in combination with clopidogrel and other medications","volume":"123","author":"L A Garc\u00eda 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