Presentation Details
| Analysis of pharmacist interventions within a direct oral anticoagulation management protocol Clara J Nickel2, Anne E Rose1. 1University of Wisconsin Health, Madison, WI, USA.2University of Wisconsin School of Pharmacy, Madison, WI, USA |
Abstract
Background: Direct oral anticoagulants (DOACs) are first line treatment options for nonvalvular atrial fibrillation and venous thromboembolism. In comparison to warfarin, DOAC therapy does not require regular therapeutic monitoring, which allows individual institutions the freedom to define their own structure for DOAC management. Common approaches for DOAC management include a population-based model where patients are flagged when potential issues are identified or a predetermined check-in model where patients are contacted at pre-set time points. Within UW Health’s Anticoagulation Clinic, pharmacists contact DOAC patients at pre-set time points of initial visit, 3 weeks, 6 months, and 12 months post DOAC start date. During each visit, the pharmacist assesses for medication efficacy, medication changes, compliance, adverse effects, and need for periprocedural planning. Currently, there is a paucity of evidence defining an optimal protocol for the management of DOACs. This study aims to evaluate the timing and types of interventions made within the first year of DOAC therapy at pre-set contact times and outside of scheduled contact times to determine if a change is needed to our DOAC management protocol. Methods: A single-center retrospective review was performed of all patients currently managed by the Anticoagulation Clinic at UW Health as of June 8, 2023. Patients were included if aged 18 years and older and within the first year of DOAC therapy. Patients were excluded from analysis if they had been on the anticoagulant prior to enrollment in the service or were hemodynamically unstable. The primary objective was to assess current monitoring practices by tracking the number and types of interventions made during and outside of predefined contact points. Baseline characteristics were also collected to evaluate appropriateness of dosing. Results: A total of 427 interventions were performed by pharmacists for the 113 eligible patients. Approximately two thirds of the interventions (289/427, 67.7%) were completed within the predefined contact points and one third of interventions (138/427, 32.3%) were completed outside of the predefined contact points. Within the predefined contact points, the most common interventions were eligibility review and the initial DOAC visit (237/289, 82%). Few interventions were made at the 3-week and 6-month contact point (each 20/427, 4.7%); most were related to lab monitoring or periprocedural planning. One dose change was made at 6 months. The most common interventions during the predefined contact points included initial education (33%), ordering labs (27%), ensuring ability for patients to afford medications (24%), and optimizing DOAC regimen (5%) which included changing to an alternative DOAC, changing DOAC dose, and discontinuing interacting medications. The most common interventions made outside of predefined contact points included coordinating and reviewing labs (38%), periprocedural planning (27%), and optimizing DOAC regimen (8%) including adverse effect management. Conclusion: Most pharmacist interventions are made during the initial visit and outside of predefined contact points. This would support the preference for a population-based model that identifies patients who need pharmacist intervention versus those with a pre-set contact time.
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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.