Assessment of a Pharmacist-Led Direct Oral Anticoagulant Monitoring Clinic

• Main Authors: Haché, Jenna, Bonsu, Kwadwo Osei, Chitsike, Rufaro, Nguyen, Hai, Young, Stephanie
• Format: Text
• Language: English
• Published: Canadian Society of Hospital Pharmacists 2021
• Subjects: Original Research; Newfoundland
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801335/; http://www.ncbi.nlm.nih.gov/pubmed/33487649

BACKGROUND: Direct oral anticoagulants (DOACs) are recommended as first-line therapy for treatment and prevention of venous thromboembolism (VTE) and prevention of stroke related to nonvalvular atrial fibrillation. Recent publications have suggested incorporating DOAC monitoring into anticoagulant management clinics. The Eastern Health Adult Outpatient Thrombosis Service (Newfoundland and Labrador) includes a pharmacist-led DOAC monitoring clinic that uses standardized evidence-based care processes. OBJECTIVES: To describe a new pharmacist-led DOAC monitoring clinic and to assess patients’ adherence to medication therapy, adherence to guideline-recommended frequencies for blood work, and adverse and non-adverse events. METHODS: This retrospective chart review involved patients who attended their first visit to the DOAC clinic between October 10, 2017, and May 31, 2018. Patients were followed until November 30, 2018. Data were abstracted from electronic hospital records and the provincial pharmacy network. Descriptive statistics were used to analyze the data: categorical variables were presented as frequencies and percentages; continuous variables were analyzed and presented as means with standard deviations and, where applicable, as medians with interquartile ranges. RESULTS: Forty-seven patients, who attended a total of 74 clinic visits, were included. Twenty-eight patients (60%) were adherent to their DOAC therapy. All patients had blood work completed before each clinic appointment. The mean time between the first and second sets of blood tests was 6.2 (standard deviation [SD] 1.4) months and between the second and third sets of blood tests was 5.1 (SD 1.0) months. There were no episodes of VTE or major bleeding. There was 1 cerebrovascular accident (3.2 events per 100 person-years, 95% confidence interval [CI] 0.2–15.7) and 5 episodes of clinically relevant non-major bleeding (12.8 events per 100 person-years, 95% CI 4.1–30.1). Pharmacists identified 51 issues at the clinic appointments, of which 48 were ...