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Expanding anticoagulation management services to include direct oral anticoagulants

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Abstract

Despite the ease of use of direct oral anticoagulants (DOACs), these agents remain high risk medications and their clinical efficacy can be impacted by factors such as patient adherence, drug procurement barriers, bleeding leading to discontinuation, and prescribing that deviates from approved dosing regimens. Clinical monitoring of patients on DOACs should be performed by clinicians who specialize in anticoagulation and are familiar with the nuances of DOAC dosing, monitoring, and other components of anticoagulation management including peri-procedural management and care transitions. Although data for centralized warfarin management have consistently demonstrated improved clinical outcomes compared to traditional management by individual community providers, there are no published data addressing the impact of centralized management of DOACs on clinical outcomes or anticoagulation control. In addition, there is currently no consensus on how to incorporate patients on DOACs into this centralized model, despite recommendations for systematic follow-up by both the Anticoagulation Forum and the Institute for Safe Medication Practices. Based on the national recommendations and an identified institutional need, the Brigham and Women’s Hospital Anticoagulation Management Service implemented a pilot program to expand services to include patients newly initiated on, or transitioned to, a DOAC. We describe our model for expansion of the AMS to include patients on DOACs.

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Authors and Affiliations

  1. Department of Pharmacy Services, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Katelyn W. Sylvester, Andrea Lewin & Peter Collins

  2. Bouve College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA

    Clara Ting & John Fanikos

  3. Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Samuel Z. Goldhaber

  4. Division of Hematology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Jean M. Connors

Authors
  1. Katelyn W. Sylvester
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  2. Clara Ting
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  3. Andrea Lewin
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  4. Peter Collins
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  5. John Fanikos
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  6. Samuel Z. Goldhaber
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  7. Jean M. Connors
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Corresponding author

Correspondence to Katelyn W. Sylvester.

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Conflict of interest

Katelyn Sylvester has participated on a scientific advisory board for Bristol Meyers Squibb/Pfizer. Clara Ting declares that she has no conflict of interest. Andrea Lewin declares that she has no conflict of interest. Peter Collins declares that he has no conflict of interest. John Fanikos has acted as a consultant for Portola and Boehringer Ingelheim. Samuel Z. Goldhaber has received research support from BiO2 Medical, Bristol Meyers Squibb, Boehringer Ingelheim, BTG EKOS, Daiichi and Janssen. He has acted as a consultant for Agile, Bayer, Boehringer Ingelheim, Bristol Meyers Squibb, Daiichi, Janssen, Porola and Zafgen. Jean M. Connors has acted as a consultant for Bristol Meyers Squibb, has participated on Scientific advisory boards for Boehringer Ingelheim and Bristol Meyers Squibb and has participated on the Data Safety Monitoring Committee for Unum.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Sylvester, K.W., Ting, C., Lewin, A. et al. Expanding anticoagulation management services to include direct oral anticoagulants. J Thromb Thrombolysis 45, 274–280 (2018). https://doi.org/10.1007/s11239-017-1602-1

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  • DOI: https://doi.org/10.1007/s11239-017-1602-1

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