The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring
- PDF / 634,872 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 102 Downloads / 143 Views
The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring Aubrey E. Jones1,3 · Jordan B. King2 · Kibum Kim1 · Daniel M. Witt1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The role of dedicated anticoagulation management services (AMS) for patients receiving direct oral anticoagulant (DOAC) therapy is unclear. The objective of our study was to describe DOAC management in patients who were and were not managed by an AMS. We conducted a retrospective cohort study among patients with atrial fibrillation at the University of Utah Health (UUH) who received DOAC therapy between January 2013 and June 2016. Patients in the AMS group were managed by a pharmacist-led AMS whereas those in the non-AMS group were managed by other providers. The number and type of provider encounters and interventions related to DOAC therapy and a composite endpoint of thromboembolism, bleeding, and all-cause mortality were recorded. Overall, 90 and 370 patients were managed in the AMS and non-AMS groups, respectively. AMS group patients had greater chronic disease burden as measured by the Charlson comorbidity index. AMS group patients had more frequent DOAC-related encounters than non-AMS group patients but both groups had similar DOAC therapy intervention rates. Over half of patients in the AMS group received potentially duplicative interventions from their regular clinicians. The composite endpoint occurred in 18.9% and 13.5% of AMS and non-AMS group patients, respectively (p = 0.29). Patients managed by AMS providers were more complex and had more frequent encounters regarding their DOAC therapy than those managed by non-AMS providers. However, there was evidence of duplicative DOAC therapy management efforts. No difference between AMS and non-AMS groups in the composite clinical endpoint was detected. Keywords DOAC · Anticoagulation · Pharmacist management · Bleeding · NOAC
Highlights • Patients on direct oral anticoagulants (DOACs) referred
to anticoagulation management services (AMS) tended to be more complicated.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02064-0) contains supplementary material, which is available to authorized users. * Aubrey E. Jones [email protected] 1
Department of Pharmacotherapy, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112, USA
2
Population Health Sciences, University of Utah, Salt Lake City, UT, USA
3
University of Utah College of Pharmacy, 30 South 2000 East, Salt Lake City, UT, USA
• Duplicative efforts in DOAC management between AMS
pharmacists and non-AMS providers are likely occurring.
• No difference in clinical endpoints between AMS and
non-AMS groups were observed.
• Periprocedural planning interventions occurred com-
monly among patients on DOACs.
• Implications: More evidence is needed to fully determine
the role of AMS services in DOAC monitoring and therapy.
Introduction The use of direct oral antico
Data Loading...
