Category: Professional Posters
Purpose: Direct Oral Anticoagulants (DOACs) have been marketed as medications that don't require routine monitoring. However, as more patients are being prescribed DOACs, the need for medication management services to ensure safe and effective therapy is growing. In June 2018, the anticoagulation management service (AMS) expanded to include patients on DOACs (apixaban ,rivaroxaban, dabigatran). The objective of this report is to identify the most common types of interventions required and time needed to manage DOAC patients as well as to evaluate if a DOAC management program could help to reduce rates of admissions due to clotting/bleeding.
Methods: The pharmacist-run service provides patients with education, cost reduction resources, refills, perioperative management, and initial and follow up screening for appropriate dosing, medication interactions/adherence, and treatment duration. An anticoagulation management software system was utilized by AMS to schedule follow-up and to document clinical visits for patients on DOACS. In addition, a pharmaco-surveillance system was utilized to categorize the types and time needed to complete each clinical intervention. Clinical interventions were classified into the following types: medication compliance, dosing changes, adverse effects, duration of therapy, insurance interventions, medication interactions, perioperative interventions, renal evaluation, transitioning between different anticoagulants, new patient education, and scheduled DOAC follow-up. A retrospective review of patient charts from June 1, 2018 to February 1, 2019 was conducted in order to identify the frequency and type of clinical interventions made for DOAC patients enrolled in the service. In addition, a retrospective review of the hospital information system during this same time period was utilized to identify any patients admitted to the hospital due a bleeding or clotting event while on a DOAC medication utilizing ICD-10 diagnosis codes. Patients were excluded from this analysis if they were less than 18 years of age or for DVT prophylaxis following orthopedic surgery.
Results: The AMS enrolled 117 patients (apixaban 79%, rivaroxaban 21%, and dabigatran 1%) into its DOAC program from June 1, 2018 to February 1, 2019 and charted 725 clinical visits during the study period. The most common intervention types included new patient education (65%), dosing changes due to hepatic/renal function (12%), transitioning between anticoagulants (11%), insurance interventions (11%), and perioperative management (8%). 2 of the 117 enrolled AMS patients (1.7%) experienced a bleeding/clotting complication requiring admission. A total of 193 hours were spent managing DOAC patients which is an average of 5 visits/patient or 0.6 visits/patient/month (approximately 12 minutes/patient/month). Concurrent inpatient data was also reviewed and identified 62 patients admitted with a clotting/bleeding event on a DOAC. GI bleeding (48%) followed by CVA/TIA (15%) were the most common adverse events observed. Of the 62 total admissions, 2 were AMS patients (3%). This analysis also identified that 18 of the 62 patients admitted (29%) were on an incorrect dose , had inappropriate DOAC usage, or inappropriate frequency of administration.
Conclusion: This data suggests that DOAC management through a centralized service prevents adverse events leading to hospitalization and offers potential cost-saving opportunities by reducing hospital admissions.