Recommended Citation
Alessa M, Kuhr-Bailey L, Herrera G. Increase Anticoagulation Stewardship by Implementing Direct Oral Anticoagulant Monitoring by Anticoagulation Clinics. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
DOAC (Direct Oral Anticoagulant) use has significantly increased over warfarin, supported by clinical guidelines for conditions like nonvalvular atrial fibrillation and venous thromboembolism. A study by Geller et al. using data from 60 U.S. hospitals and a national prescription database showed DOAC use rose to 83.6% by 2020, while warfarin declined to 41.2%. Rising DOAC use highlights the need for structured monitoring. To address this, Advocate Lutheran General Hospital implemented a pharmacist-run DOAC monitoring service to enhance anticoagulation stewardship.
Purpose:
To implement a comprehensive DOAC monitoring service and improve safe, effective use of anticoagulation therapy.
Methods:
This prospective, observational, single-center study included adults discharged on DOACs, excluding patients under 18, in hospice/long-term care, on short-term DOACs post-orthopedic surgery, or with a Watchman device. A collaborative practice agreement allowed pharmacists to order referrals under a physician’s name. Educational tools and pharmacist surveys were developed. Data were collected through chart review in the electronic medical record (EMR). Enrollment began on November 1, 2024, with initial visits starting on November 15. Data collection continued through February 1, 2025.
Results:
Of the monitored patients, 74% were treated for atrial fibrillation, 19% for venous thromboembolism, and 6% for other reasons. Most (76%) were continuing therapy; 22% were new starts. Apixaban was used in 88% of cases, Rivaroxaban in 12%. Dosing accuracy was 93%, with 1% underdosed and 6% overdosed. Risk-based follow-ups were set at 3 months for high-risk (56%), 6 months for moderate (33%), and 12 months for low-risk (9%). Only 7% had cost issues, and 2% reported adherence concerns. Drug interactions were seen in 7%, primarily with Diltiazem. Antiplatelet/NSAID use occurred in 45%, mostly aspirin. Bleeding occurred in 7%, bruising in 6%; 9% required DOAC interruption. All hospitalizations were unrelated to DOACs.
Conclusions:
The pharmacist-led DOAC service improved post-discharge anticoagulation management through structured monitoring, early issue detection, and individualized follow-up. Despite outreach and enrollment challenges, it demonstrated strong clinical value. Future steps include extending follow-up, automating enrollment, enabling cost lookups by insurance, and expanding to other Advocate sites.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Increase Anticoagulation Stewardship by Implementing Direct Oral Anticoagulant Monitoring by Anticoagulation Clinics
Background/Significance:
DOAC (Direct Oral Anticoagulant) use has significantly increased over warfarin, supported by clinical guidelines for conditions like nonvalvular atrial fibrillation and venous thromboembolism. A study by Geller et al. using data from 60 U.S. hospitals and a national prescription database showed DOAC use rose to 83.6% by 2020, while warfarin declined to 41.2%. Rising DOAC use highlights the need for structured monitoring. To address this, Advocate Lutheran General Hospital implemented a pharmacist-run DOAC monitoring service to enhance anticoagulation stewardship.
Purpose:
To implement a comprehensive DOAC monitoring service and improve safe, effective use of anticoagulation therapy.
Methods:
This prospective, observational, single-center study included adults discharged on DOACs, excluding patients under 18, in hospice/long-term care, on short-term DOACs post-orthopedic surgery, or with a Watchman device. A collaborative practice agreement allowed pharmacists to order referrals under a physician’s name. Educational tools and pharmacist surveys were developed. Data were collected through chart review in the electronic medical record (EMR). Enrollment began on November 1, 2024, with initial visits starting on November 15. Data collection continued through February 1, 2025.
Results:
Of the monitored patients, 74% were treated for atrial fibrillation, 19% for venous thromboembolism, and 6% for other reasons. Most (76%) were continuing therapy; 22% were new starts. Apixaban was used in 88% of cases, Rivaroxaban in 12%. Dosing accuracy was 93%, with 1% underdosed and 6% overdosed. Risk-based follow-ups were set at 3 months for high-risk (56%), 6 months for moderate (33%), and 12 months for low-risk (9%). Only 7% had cost issues, and 2% reported adherence concerns. Drug interactions were seen in 7%, primarily with Diltiazem. Antiplatelet/NSAID use occurred in 45%, mostly aspirin. Bleeding occurred in 7%, bruising in 6%; 9% required DOAC interruption. All hospitalizations were unrelated to DOACs.
Conclusions:
The pharmacist-led DOAC service improved post-discharge anticoagulation management through structured monitoring, early issue detection, and individualized follow-up. Despite outreach and enrollment challenges, it demonstrated strong clinical value. Future steps include extending follow-up, automating enrollment, enabling cost lookups by insurance, and expanding to other Advocate sites.
Affiliations
Advocate Lutheran General Hospital