Reasons for new patient warfarin referrals to an anticoagulant management service in 2019: a single institution experien
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Reasons for new patient warfarin referrals to an anticoagulant management service in 2019: a single institution experience Katelyn W. Sylvester1 · Caroline Wagner1,2 · Andrea Lewin1 · John Fanikos1 · Samuel Z. Goldhaber3 · Jean M. Connors4 Accepted: 25 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Background
Methods
Direct oral anticoagulants (DOACs) are as effective as warfarin, with a favorable safety profile, and improved ease of use. Guidelines recommend DOACs as first line management for non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE) [1, 2]. The proportion of Medicare anticoagulant claims for DOACs increased from 0.2% in 2010 to 46.5% in 2017 [3]. Despite the advantages that DOACs offer, warfarin remains the best evidence-based treatment option for select indications and specific patient populations such as patients with triple positive antiphospholipid syndrome (APLS), durable ventricular assist devices (VAD), mechanical heart valves with or without AF, or left ventricular thrombi where warfarin was found to be superior to DOACs [4–7]. Additionally, some patient populations were underrepresented in the DOAC landmark trials (i.e. severe renal insufficiency, morbid obesity, and cancer), resulting in limited data regarding their efficacy and safety. This report evaluates the indications for new patient referrals to the Brigham and Women’s Hospital (BWH) Anticoagulation Management Service (AMS) for warfarin management as well as the referring provider rationale for selecting warfarin over a DOAC.
A retrospective chart review was performed on all new patients referred to BWH AMS for warfarin management from January 1, 2019 to September 5, 2019. BWH is a 793bed academic medical center and teaching affiliate of Harvard Medical School. The BWH AMS is a pharmacist-run telephone-based clinic managing more than 2600 patients on warfarin therapy. Patient charts were reviewed for anticoagulation indication and rationale for choice of anticoagulant (if documented). Referrals submitted to BWH AMS through our electronic health record (EHR) were reviewed for indication for anticoagulation and EHR provider notes were reviewed to determine the rationale for selecting warfarin for oral anticoagulation. All records were reviewed independently by two AMS staff.
* Jean M. Connors [email protected] 1
Department of Pharmacy Services, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
2
Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
3
Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
4
Division of Hematology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115, USA
Results Of 820 total referrals the BWH AMS received for anticoagulation management during the study period, 620 (75.6%) were referred for warfarin management. Indications for anticoagulation included orthopedic post-operative VTE prophyla
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