The introduction of direct oral anticoagulants (DOACs) to the market has expanded anticoagulation options for outpatient use. Routine evaluation by health care professionals is recommended as it is with warfarin, therefore requiring adjustments in practices of anticoagulation management services (AMS). This study aims to describe trends that occurred following the incorporation of DOACs into AMS at a large academic medical center. A retrospective chart review of pharmacist-run AMS was used to compare patients on DOAC therapy versus other types of anticoagulation, including warfarin and parenteral agents. Primary outcomes included trends in the number of unique patients, management encounters, and telephone encounters throughout the study period. Secondary outcomes included trends in new encounters, and changes in patient characteristics, resources utilized, and patient satisfaction scores. A total of 2976 unique patients, 74,582 management encounters, and 13,282 telephone encounters were identified. From study beginning to end, results showed stable numbers of unique patients, an increase in management encounters for the DOAC group and decrease in the other anticoagulants group, and stable numbers of telephone encounters. Additionally, the number of new encounters for both groups increased. Throughout the study, pharmacy resources were reallocated within anticoagulation to adapt to the changing trends and patient satisfaction reached targets. Patients' characteristics remained stable, with the DOAC group having fewer comorbid conditions and concomitant medications that could increase bleed risk. This study showed that by reallocating resources within anticoagulation, AMS can maintain stable patient populations while continuing to expand access and satisfy patients following DOAC inclusion.

Management of patients with antiphospholipid syndrome on warfarin therapy can be challenging. The international normalized ratio (INR) of patients with antiphospholipid syndrome can be falsely elevated. This elevation is thought to be reflective of the reaction of the antiphospholipid antibody with the thromboplastin used to measure the protime. This false elevation can be seen in both venipuncture and point-of-care results. This discrepancy is usually more apparent in patients with whose INR is tested using point of care. As a result, there is a preference for venipuncture INR testing in most patients with antiphospholipid syndrome requiring warfarin therapy. In our case, we highlight one patient who we correlated her venipuncture INR with point-of-care INR as well as a chromogenic factor X level in order to manage her INR by point-of-care INR testing.

American Journal of HematologyVolume 89, Issue 6 p. E1-E101 AbstractsFree Access Abstract Proceedings of the 2014 Thrombosis and Hemostasis Summit of North America First published: 10 May 2014 https://doi.org/10.1002/ajh.23759Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume89, Issue6June 2014Pages E1-E101 RelatedInformation