Conclusion:
This study illustrates that inappropriate combined antithrombotic therapy is observed frequently among hospitalized patients, which could result in an altered benefit-risk ratio for these patients. Optimal and safe antithrombotic use can be stimulated by implementing an antithrombotic stewardship that evaluates patients using combined antithrombotic therapy, prevents overuse of the combined therapy by adequate documentation of duration of therapy when combined therapy is initiated and a structured validation of the indication for the combined antithrombotic therapy when patients are already using combined antithrombotic therapy.
Future studies are needed to conclude whether these interventions will lead to a decrease of patients entering the hospital with a major bleeding using combined antithrombotic therapy without increasing the number of thromboembolic events among these patients.