Impact of pharmacist-driven management of direct oral anticoagulants: A preliminary observational study
Location
Suwanee, GA
Start Date
14-5-2019 1:00 PM
End Date
14-5-2019 4:00 PM
Description
Introduction: Direct oral anticoagulants (DOACs) are common alternatives to warfarin. Contrary to many providers’ beliefs, evidence and expert opinion support the importance of follow-up monitoring for patients on these DOACs. The objective of this observational study is to evaluate the impact of a pharmacist-driven DOAC monitoring program to ensure the efficacy and safety of DOAC therapy.
Method: A monitoring checklist was developed for each DOAC and implemented as part of the new DOAC management service at Backus Hospital Medication Management Clinic in Norwich, CT. Local primary care providers, cardiologists, and hematologists referred patients to this DOAC management service on as-needed basis. Patients are assessed based on the ABCDEF criteria: adherence (A), bleeding risk (B), creatinine clearance (C), drug interaction (D), education (E), final assessment and plan/follow up (F). Baseline characteristics and types of interventions made were collected to evaluate the impact of the service.
Results: A total of 17 patients were referred to the DOAC management service between September 2016 and April 2018 with indication for venous thromboembolism (n=5) and nonvalvular atrial fibrillation (n=11). 1 patient was on apixaban but referred for enoxaparin bridging for an upcoming procedure. Referred patients were treated with apixaban (n=9), rivaroxaban (n=5), or dabigatran (n=2), but none with edoxaban. All patients received education on risks vs benefits of DOAC therapy, adverse drug reactions, safe over-the-counter drugs, alcohol use, and adherence. 2 patients needed dosage adjustment due to renal insufficiency and presence of 2/3 risk factors. 8 patients required switching agents during the course of treatment due to treatment failure, cost, non-bleeding adverse events, and non-adherence. These 8 patients were assisted with transition between DOAC and warfarin as well.
Discussion: Pharmacists play an important role in managing DOAC therapy. Even with the small number of patients in this observational study, we can suspect that pharmacist-driven DOAC management service can have positive impacts on patient’s health outcome. With the use of the ABCDEF checklists, pharmacists can effectively manage DOAC therapy.
Embargo Period
1-28-2020
Impact of pharmacist-driven management of direct oral anticoagulants: A preliminary observational study
Suwanee, GA
Introduction: Direct oral anticoagulants (DOACs) are common alternatives to warfarin. Contrary to many providers’ beliefs, evidence and expert opinion support the importance of follow-up monitoring for patients on these DOACs. The objective of this observational study is to evaluate the impact of a pharmacist-driven DOAC monitoring program to ensure the efficacy and safety of DOAC therapy.
Method: A monitoring checklist was developed for each DOAC and implemented as part of the new DOAC management service at Backus Hospital Medication Management Clinic in Norwich, CT. Local primary care providers, cardiologists, and hematologists referred patients to this DOAC management service on as-needed basis. Patients are assessed based on the ABCDEF criteria: adherence (A), bleeding risk (B), creatinine clearance (C), drug interaction (D), education (E), final assessment and plan/follow up (F). Baseline characteristics and types of interventions made were collected to evaluate the impact of the service.
Results: A total of 17 patients were referred to the DOAC management service between September 2016 and April 2018 with indication for venous thromboembolism (n=5) and nonvalvular atrial fibrillation (n=11). 1 patient was on apixaban but referred for enoxaparin bridging for an upcoming procedure. Referred patients were treated with apixaban (n=9), rivaroxaban (n=5), or dabigatran (n=2), but none with edoxaban. All patients received education on risks vs benefits of DOAC therapy, adverse drug reactions, safe over-the-counter drugs, alcohol use, and adherence. 2 patients needed dosage adjustment due to renal insufficiency and presence of 2/3 risk factors. 8 patients required switching agents during the course of treatment due to treatment failure, cost, non-bleeding adverse events, and non-adherence. These 8 patients were assisted with transition between DOAC and warfarin as well.
Discussion: Pharmacists play an important role in managing DOAC therapy. Even with the small number of patients in this observational study, we can suspect that pharmacist-driven DOAC management service can have positive impacts on patient’s health outcome. With the use of the ABCDEF checklists, pharmacists can effectively manage DOAC therapy.