Announcement
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Anticoagulation Stewardship in the Real-World Setting Nghi Ha, Denise Sutter-Long, Anisa Bici, Erin Mouland, Elizabeth Renner. Michigan Medicine, Ann Arbor, MI, USA |
Abstract
The need for anticoagulation therapy has increased over time due to increased prevalence of disease states such as atrial fibrillation (Afib) and venous thromboembolism (VTE) associated with an aging population. Unfortunately, anticoagulants are the most frequent medication class associated with ED visits in patients over the age of 65 years old. As a result, the concept of antithrombotic stewardship (ATS) was introduced to improve effective use while addressing the negative effects of anticoagulation therapy. ATS is defined as the coordinated, efficient, and sustainable system-level initiatives designed to achieve optimal anticoagulation-related health outcomes and minimize avoidable adverse drug events. The purpose of this abstract is to describe various clinical practices used to incorporate ATS at a tertiary academic health system. Admission/Inpatient: On admission, medication reconciliation verifies a patient’s current anticoagulation regimen. While admitted, anticoagulated patients are identified on an anticoagulation dashboard that requires clinical pharmacists to assess appropriateness of dosing and therapeutic goal range at initiation and with every therapeutic laboratory result or at least once every 24 hours. Transition of care: If a new anticoagulant is initiated, patients also undergo cost assessment to ensure affordability in the outpatient setting. At discharge, patients receive patient education. Patients can also be referred to the outpatient anticoagulation service (ACS) for follow up. Anticoagulation care plans are communicated to patients’ anticoagulation provider at discharge. If patients are referred to the outpatient ACS, they are enrolled into the service and receive additional patient education. Clinical pharmacist specialists review every new patient for appropriateness of dosing, therapeutic goal, significant drug-drug interactions, and duration of therapy at time of enrollment. Outpatient: Patients on warfarin are assigned to a team for INR monitoring and dose modification. Higher risk patients (e.g. left ventricular assist device) are managed by clinical pharmacist specialists for closer monitoring. Patients newly diagnosed with Afib, VTE, or other conditions in the outpatient setting can be referred to ACS for therapy assessment and initiation or monitoring. Pharmacist specialists review each case for appropriateness of therapeutic options, dosing, indication, cost, and treatment duration. Pharmacists then reach out to patients to discuss and facilitate therapy initiation and provide patient education. Care plans and documentation are communicated and coordinated with patients’ referring providers. Patients on direct oral anticoagulants (DOACs) are monitored and managed through a population management approach through a DOAC Dashboard. This approach allows a small team of anticoagulation providers to manage over 19,000 patients on DOACs within the health system, providing an efficient method of identifying patients on DOACs that require dose or therapeutic modification. Finally, the ACS has a robust perioperative management program that assists patients on anticoagulation undergoing procedures through both a referral-based and systematic approach. In addition to a specific perioperative referral, the ACS currently provides perioperative management for all anticoagulated patients undergoing cardiac catheterization and endoscopic procedures. Conclusion: This summary is an example of ATS in practice. The multiple touchpoints throughout patients’ anticoagulation experience help ensure that anticoagulation therapy is managed to maximize efficacy and safety.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.