{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:25:07Z","timestamp":1786944307121,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Initiation or re\u2010initiation of warfarin often requires enoxaparin bridging, a period associated with increased bleeding risk. Anticoagulation stewardship (ACS) teams may improve the safety of anticoagulant management; however, their impact on bridging delivered by Hospital in the Home (HITH) is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To determine the impact of ACS\u2010guided anticoagulation management on bleeding, thrombosis and other outcomes in patients admitted to HITH for enoxaparin\u2010warfarin bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a pre\u2010 (November 2020\u2013November 2022) and post\u2010implementation (April 2023\u2013November 2024) comparative cohort study of patients referred to HITH for warfarin\u2010enoxaparin bridging. In the post\u2010implementation phase, the ACS team provided individualised bridging plans and weekly chart reviews. The primary outcome was a composite of bleeding (major or minor), thrombosis (venous thrombo\u2010embolism, stroke, acute myocardial infarction) or anticoagulation\u2010related readmission prior to HITH discharge. Secondary outcomes included the primary outcome assessed at 30\u2009days following discharge and incidence of supratherapeutic international normalised ratio (INR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 373 patients were identified, with 231 bridging episodes in the pre\u2010implementation period (59% male, median age 64 (50\u201377) years) and 205 bridging episodes in the post\u2010implementation period (59% male, median age 66 (54\u201377) years). Overall, there was no significant difference in the primary composite outcome following implementation, with rates of 10% and 12% respectively (\n                      <jats:italic>P<\/jats:italic>\n                      =\u20090.46). After implementation, major bleeding was reduced (2.2% vs 0%,\n                      <jats:italic>P<\/jats:italic>\n                      =\u20090.03), as was supratherapeutic INRs during warfarin titration (33% vs 21%,\n                      <jats:italic>P<\/jats:italic>\n                      =\u20090.01). No significant outcome differences were observed in the 30 days after discharge from HITH.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ACS\u2010guided anticoagulation plans and routine reviews did not reduce a composite of bleeding, thrombosis or anticoagulation\u2010related rehospitalisation in patients managed in HITH. ACS may be associated with less major bleeding and fewer episodes of supratherapeutic INR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.70590","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:56:24Z","timestamp":1786942584000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anticoagulation stewardship team oversight of enoxaparin\u2010warfarin bridging delivered by Hospital in the Home: a pre\u2010 and post\u2010implementation study"],"prefix":"10.1111","author":[{"given":"Suebsakul","family":"Pripanapong","sequence":"first","affiliation":[{"name":"Department of General Medicine Monash Health  Melbourne Victoria Australia"},{"name":"Hospital in the Home Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sing Ning","family":"Yeoh","sequence":"additional","affiliation":[{"name":"Emergency Department Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jahan","family":"Zaib","sequence":"additional","affiliation":[{"name":"Emergency Department Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Lim","sequence":"additional","affiliation":[{"name":"Pharmacy Department Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadishani","family":"Ratnayake","sequence":"additional","affiliation":[{"name":"Pharmacy Department Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Taylor","sequence":"additional","affiliation":[{"name":"Pharmacy Department Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Leitinger","sequence":"additional","affiliation":[{"name":"Department of Haematology Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Rogers","sequence":"additional","affiliation":[{"name":"Hospital in the Home Monash Health  Melbourne Victoria Australia"},{"name":"Department of Infectious Diseases Monash Health  Melbourne Victoria Australia"},{"name":"School of Clinical Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Potter","sequence":"additional","affiliation":[{"name":"Department of General Medicine Monash Health  Melbourne Victoria Australia"},{"name":"School of Clinical Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1076029617706756"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.105221"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.011777"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2022.07.025"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.12070"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.002"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14542"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/rth2.12758"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arcmed.2022.11.016"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-019-00834-2"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0235048"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-016-1455-z"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tru.2022.100125"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.16655"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_7_18_1","unstructured":"Available from URL:https:\/\/www.mdcalc.com\/calc\/801\/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk. 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