Edward Lee Carter: How A Landmark Stewardship Shift Reduced Unnecessary Antiplatelet Use Across VISN 8

Edward Lee Carter, Clinical Pharmacist Practitioner at U.S. Department of Veterans Affairs, shared on LinkedIn:

”Yesterday marked a major milestone for antithrombotic stewardship within the Veterans Health Administration (VHA).

A groundbreaking study led by Dr. Jacob Kurlander and an exceptional team of clinician‑scientists, pharmacists, data experts, and implementation leaders was published in JAMA Internal Medicine, accompanied by an invited editorial and featured podcast discussion.

Their work provides some of the clearest evidence yet that thoughtful, system‑level stewardship can meaningfully reduce unnecessary and potentially harmful antiplatelet use in Veterans receiving DOAC therapy.

This multilevel stewardship initiative—launched across VISN 8 (Florida, Georgia, Puerto Rico, U.S. Virgin Islands)—showed that a combination of educational outreach, targeted EHR enhancements, and a clinical pharmacist‑facing electronic flag drove substantial and sustained reductions in antiplatelet use, declining from 26.1% to 17.9% over the intervention period.

Control sites saw far smaller changes during the same timeframe.

Notably, Veterans with stable coronary artery disease—a group for whom antiplatelet deimplementation is both safe and guideline‑supported—experienced the greatest benefit, with reductions of 2.1 percentage points every 6 months.

This represents a meaningful step forward in reducing preventable bleeding events.

The accompanying editorial underscored that this model is not only clinically impactful but also clinician‑friendly, reducing unnecessary cognitive load by shifting stewardship responsibilities to skilled clinical pharmacists.

As the editorialists noted, this type of systems‑based intervention has the power to ‘benefit many patients’ while also supporting the clinicians who care for them.

A few well‑deserved shout‑outs:

• Jacob Kurlander, MD, MS — for leading a rigorous, practice‑changing evaluation.
• David Parra, PharmD — whose vision, leadership, and academic‑detailing expertise shaped and operationalized this multistage intervention across VISN 8.
• All VISN 8 anticoagulation pharmacists and program leaders — you continue to set the national benchmark for antithrombotic stewardship, achieving some of the lowest concomitant APT‑OAC use in the entire VHA.

This publication is a powerful reminder of what can be achieved when clinicians, pharmacists, and system leaders unite around a shared mission: safer, more evidence‑driven care for the Veterans we serve.

Congratulations to the researchers and the entire team on this landmark contribution to cardiovascular safety.

Study (Original Investigation):
Multilevel Stewardship Intervention for Use of Anticoagulation–Antiplatelet Therapy

Editorial:
Deprescribing Inappropriate Medicines Across a Health System — Can We Improve the Care of Both Patients and Physicians?”

Title 1: Multilevel Stewardship Intervention for Use of Anticoagulation-Antiplatelet Therapy

Authors: Jacob E. Kurlander, David Parra, Von Moore, Rob Holleman, Jennifer Burns, Amanda M. Midboe, Brittani Garlick, Ariel Domlyn, Linda Chia, Geoffrey D. Barnes, H. Myra Kim, Jeremy B. Sussman

Title 2: Deprescribing Inappropriate Medicines Across a Health System—Can We Improve the Care of Both Patients and Physicians?

Authors: C. Seth Landefeld, Michael A. Steinman

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